Brustan Overdosage

Ibuprofen: Approximately 1½ hours after the reported ingestion of from 7 to 10 Ibuprofen Tablets (400mg), a 19-month old child weighing 12 kg was seen in the hospital emergency room, apneic and cyanotic, responding only to painful stimuli. This type of stimulus, however, was sufficient to induce respiration. Oxygen and parenteral fluids were given; a greenish-yellow fluid was aspirated from the stomach with no evidence to indicate the presence of ibuprofen. Two hours after ingestion the child's condition seemed stable; she still responded only to painful stimuli and continued to have periods of apnea lasting from 5 to 10 seconds. She was admitted to intensive care and sodium bicarbonate was administered as well as infusions of dextrose and normal saline. By four hours post-ingestion she could be aroused easily, sit by herself and respond to spoken commands. Blood level of ibuprofen was 102.9 µg/mL, approximately 8½ hours after accidental ingestion. At 12 hours she appeared to be completely recovered.
In two other reported cases where children (each weighing approximately 10 kg) accidentally, acutely ingested approximately 120 mg/kg, there were no signs of acute intoxication or late sequela. Blood level in one child 90 minutes after ingestion was 700 µg/mL about 10 times the peak levels seen in absorption excretion studies.
A 19-year old male who had taken 8,000 mg of ibuprofen over a period of a few hours complained of dizziness, and nystagmus was noted. After hospitalization, parenteral hydration and three days bed rest, he recovered with no reported sequela.
In cases of acute overdosage, the stomach should be emptied by vomiting or lavage, though little drug will likely be recovered if more than an hour has elapsed since ingestion. Because the drug is acidic and is excreted in the urine, it is theoretically beneficial to administer alkali and induce diuresis. In addition to supportive measures, the use of oral activated charcoal may help to reduce the absorption and re-absorption of ibuprofen.
Paracetamol: Symptoms of Paracetamol overdosage in the first twenty-four hours are pallor, nausea, vomiting, anorexia, and abdominal pain. Liver damage may become apparent twelve to forty-eight hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur.
Acute renal failure with acute tubular necrosis may develop even in the absence of severe liver damage. Cardiac arrhythmias have been reported. Symptoms during the first two days of acute poisoning do not reflect the potential seriousness of the overdosage. Nausea, vomiting, anorexia and abdominal pain may persist for a week or more. Liver injury may become manifest on the second day (or later), initially by elevation of serum transaminase and lactic dehydrogenase activity, increased serum bilirubin concentration and prolongation of prothrombin time. The liver damage may progress to encephalopathy, coma and death. Cerebral oedema and nonspecific myocardial depression have also occurred.
In the event of overdosage consult a doctor or take the patient to the nearest hospital immediately. Specialized treatment is essential as soon as possible. Prompt treatment is essential. Any patient who has ingested about 7.5 g of Paracetamol in the preceding four hours should undergo gastric lavage. Specific therapy with an antidote such as acetylcysteine or methionine may be necessary. If decided upon, acetylcysteine should be administered IV (intravenously) as soon as possible.
Acetylcysteine: Acetylcysteine should be administered as soon as possible, preferably within eight hours of overdosage.
Orally: 140 mg/kg as a 5% solution initially, followed by a 70 mg/kg solution every four hours for 17 doses. Acetylcysteine is effective if administered within eight hours of overdosage.
IV: An initial dose of 150 mg/kg in 200 mL glucose injection, given intravenously over fifteen minutes, followed by an intravenous infusion of 50 mg/kg in 500 ml of glucose injection over the next four hours, and then 100 mg/kg in 1000 mL over the next sixteen hours. The volume of intravenous fluids should be modified for children.