Problems for Discussion - 2 - Analgesics and Anti-inflammatory NSAID Poisoning

A 19-year-old female presents 2 hours after ingesting 50 x 200 mg of ibuprofen. She is not unwell but complains of severe epigastric pain. She refuses activated charcoal, but an intravenous catheter is inserted.

1. What is the risk of severe toxicity in this case and what are the features of severe NSAID overdose?
2. Outline the appropriate management for this patient.
3. What are the indications for activated charcoal in this case and should a nasogastric tube in inserted to allow charcoal administration?

A 35-year-old female ingested 15 x 250 mg of mefenamic acid with alcohol. She presents to the emergency department with a decreased level of consciousness and unable to give any further history.

1. What is the toxic dose for mefenamic acid?
2. Discuss the management of this patient including the management of recurrent seizures?

A 19-year-old female initially presented to hospital after ingesting 20 x 500 mg of naproxen with vomiting and epigastric pain. She had no other medical history. She was given activated charcoal and admitted overnight. She was seen the following morning and noted to be dehydrated. She was discharged home. Two days later she represented to the emergency department with bilateral loin pain.

1. What is the initial management of this patient and what are the appropriate investigations?
2. What is the management?
3. What measures during the first admission may have prevented this complication?

A 2-year-old boy weighing 14 kg is suspected to have ingested 6 x 400 mg ibuprofen tablets. He is asymptomatic.

1. Is the ingested amount potentially toxic?
2. What is the appropriate management of this child?