Brusoft Overdosage

Symptoms: There was a substantial increase in the number of cases of ibuprofen overdose reported to the National Poisons Information Service of the UK in the 2 years after its introduction as an 'over-the-counter' medication. However, no concurrent increase in severity of poisoning was found and in only 1 of 203 cases was ibuprofen thought to have caused serious problems. It was concluded that ibuprofen appeared to be much less toxic in acute overdose than either aspirin or paracetamol. Current advice is that doses below 100 mg/kg are unlikely to cause toxicity in children, whereas clinical features will occur in children who have ingested more than 400 mg/kg. In adults the dose-response effect is less clear cut, but those who have ingested less than 100 mg/kg are unlikely to require treatment.
Nonetheless, reports illustrate the complexity of major overdosage with ibuprofen.
1. A syndrome of coma, hyperkalaemia with cardiac arrhythmias, metabolic acidosis, pyrexia, and respiratory and renal failure.
2. In a 17-year-old man after major overdosage with ibuprofen and minor overdosage with doxepin. Hyperkalaemia was not evident until 14 hours after hospital admission and was thought to be due to a combination of potassium replacement for initial hypokalaemia, acidosis, muscle damage, and ibuprofen-induced renal failure.
3. A 6-year-old child developed shock, coma, and metabolic acidosis after ingestion of a dose of ibuprofen equivalent to 300 mg/kg.
4. In another report 21-month-old child had ingested the equivalent of 500 mg/kg of ibuprofen, the presenting symptoms were acute renal failure with severe metabolic acidosis. The child developed tonic-clonic seizures 46 hours after ingestion, with significant hypocalcaemia and hypomagnesaemia.
5. The seizures, which could not be controlled with diazepam, phenytoin, and phenobarbital, ceased on correction of electrolyte balance.
Treatment: Treatment consisting of intubation, mechanical ventilation, fluid resuscitation, gastric lavage, and activated charcoal proved successful.
Which may have been exacerbated by use of sodium polystyrene sulfonate and furosemide.