Nonsteroidal anti-inflammatory drug and salicylate poisoning

1. Ellie E. Rakovchik, MD* 2. Daniel M. Fein, MD* 1. *Albert Einstein College of Medicine/Children’s Hospital at Montefiore, Bronx, NY. 1. Guidance Document: Management Priorities in Salicylate Toxicity . American College of Medical Toxicity. J. Med Toxicol. 2015;11(1):149-152 [OpenUrl][1][CrossRef][2][PubMed][3] 2. 1. Bronstein AC, 2. Spyker DA, 3. Cantilena LR Jr, 4. Rumack BH, 5. Dart RC 2011 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th Annual Report. Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. Clin Toxicol (Phila). 2012;50(10):911-1164 [OpenUrl][4][CrossRef][5][PubMed][6] 3. 1. Belson MG, 2. Watson WA 1. Flomenbaum N, 2. Goldfrank L, 3. Hoffman R, 4. et al. Nonsteroidal Antiinflammatory Drugs . Belson MG, Watson WA. In: Flomenbaum N, Goldfrank L, Hoffman R, et al., eds. Goldfrank’s Toxicologic Emergencies. New York, NY: McGraw-Hill; 2006:573-578 4. 1. Flomenbaum NE 1. Flomenbaum N, 2. Goldfrank L, 3. Hoffman R, 4. et al. Salicylates. Flomenbaum NE. In: Flomenbaum N, Goldfrank L, Hoffman R, et al., eds. Goldfrank’s Toxicologic Emergencies. New York, NY: McGraw-Hill; 2006:550-564 5. 1. O’Malley GF Emergency Department Management of the Salicylate-poisoned Patient. O’Malley GF. Emerg Med Clin N Am. 2007;25(2):333-346 [OpenUrl][7][CrossRef][8][PubMed][9] Nonsteroidal-anti-inflammatory-drugs (NSAIDs) and salicylates are commonly found in over-the-counter (OTC) analgesics that are available for purchase in large quantities at relatively little cost in the United States. Consequently, they are ubiquitous in households, often in quantities that, if ingested, can cause toxicity. Analgesics (including NSAIDs, salicylates, and acetaminophen) are the most common substance class involved in all human ingestions and the second most common in children younger than 6 years of age, after cosmetics. NSAIDs function by reversibly inhibiting the enzyme cyclooxygenase (COX), thereby preventing the formation of prostaglandins, prostacyclins, and thromboxane A2 from arachidonic acid. This ultimately results in antipyretic, analgesic, and anti-inflammatory effects. There are two isoforms of COX: COX-1, which is present in all tissues, and COX-2, which is produced locally during the inflammatory response. Common OTC NSAID formulations of ibuprofen and naproxen inhibit COX-1 more than COX-2, while newer prescription NSAIDs such as celecoxib have a greater affinity for COX-2. Most NSAID ingestions in the United States involve ibuprofen. Symptoms of NSAID overdose manifest within 4 to 6 hours of ingestion. Most NSAID ingestions are asymptomatic or are associated with only minimal gastrointestinal (GI) symptoms, such as nausea, emesis, abdominal pain, and GI bleeding. Hepatic injury resulting in increased liver enzymes and liver failure can occur. Neurologic symptoms that frequently occur in the setting of NSAID ingestion are … [1]: {openurl}?query=rft.jtitle%253DJ.%2BMed%2BToxicol%26rft.volume%253D11%26rft.spage%253D149%26rft_id%253Dinfo%253Adoi%252F10.1007%252Fs13181-013-0362-3%26rft_id%253Dinfo%253Apmid%252F25715929%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1007/s13181-013-0362-3&link_type=DOI [3]: /lookup/external-ref?access_num=25715929&link_type=MED&atom=%2Fpedsinreview%2F37%2F1%2F48.atom [4]: {openurl}?query=rft.jtitle%253DClin%2BToxicol%2B%2528Phila%2529%26rft.volume%253D50%26rft.spage%253D911%26rft_id%253Dinfo%253Adoi%252F10.3109%252F15563650.2012.746424%26rft_id%253Dinfo%253Apmid%252F23272763%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/external-ref?access_num=10.3109/15563650.2012.746424&link_type=DOI [6]: /lookup/external-ref?access_num=23272763&link_type=MED&atom=%2Fpedsinreview%2F37%2F1%2F48.atom [7]: {openurl}?query=rft.jtitle%253DEmergency%2Bmedicine%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DEmerg%2BMed%2BClin%2BNorth%2BAm%26rft.aulast%253DO%2527malley%26rft.auinit1%253DG.%2BF.%26rft.volume%253D25%26rft.issue%253D2%26rft.spage%253D333%26rft.epage%253D346%26rft.atitle%253DEmergency%2Bdepartment%2Bmanagement%2Bof%2Bthe%2Bsalicylate-poisoned%2Bpatient.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.emc.2007.02.012%26rft_id%253Dinfo%253Apmid%252F17482023%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=10.1016/j.emc.2007.02.012&link_type=DOI [9]: /lookup/external-ref?access_num=17482023&link_type=MED&atom=%2Fpedsinreview%2F37%2F1%2F48.atom