To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
History |
Ask specifically about acetaminophen and aspirin ingestion |
Ascertain type of NSAID, amount ingested, when ingested |
Clinical and laboratory features |
NSAIDS are usually well tolerated in overdose, with minimal toxicity |
Severe acute overdose may result in alterations in mental status, seizure, metabolic acidosis, or renal insufficiency |
Anaphylaxis may occur |
Diagnostic evaluation |
Basic electrolytes to assess concentrations and acid-base status; baseline renal function (indicated only in moderate to severe overdose) |
Acetaminophen and salicylate concentrations to rule out concurrent pain medication ingestion |
Fingerstick glucose to rule out hypoglycemia as an etiology of any alteration in mental status |
Electrocardiogram to assess for toxin-induced prolongation of the QRS or QTc intervals |
Arterial or venous blood gas in severe overdose or altered mental status |
Pregnancy test for women of child-bearing age |
Treatment |
Secure airway, breathing, and circulation (rarely an issue in pure NSAID poisoning) |
Give gastrointestinal decontamination if patient presents within two hours of acute ingestion: Activated charcoal, 1 g/kg (maximum dose 50 g) |
There is no antidote for NSAID poisoning; supportive care will usually suffice |