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J. Med. Toxicol. (2015) 11:102105 DOI 10.1007/s13181-014-0396-1
TOXICOLOGY OBSERVATION
Massive Naproxen Overdose with Serial Serum Levels
Suad A. Al-Abri & Ilene B. Anderson & Fatehi Pedram &
Jennifer M. Colby & Kent R. Olson
Published online: 23 April 2014# American College of Medical Toxicology 2014
AbstractContext Massive naproxen overdose is not commonly reported. Severe metabolic acidosis and seizure have been described, but the use of renal replacement therapy has not been studied in the context of overdose.
Case Details A 28-year-old man ingested 70 g of naproxen along with an unknown amount of alcohol in a suicidal attempt. On examination in the emergency department 90 min later, he was drowsy but had normal vital signs apart from sinus tachycardia. Serum naproxen level 90 min after ingestion was 1,580 mg/L (therapeutic range 2575 mg/L). He developed metabolic acidosis requiring renal replacement therapy using sustained low efficiency dialysis (SLED) and continuous venovenous hemofiltration (CVVH) and had recurrent seizure activity requiring intubation within 4 h from ingestion. He recovered after 48 h.
Discussion Massive naproxen overdose can present with serious toxicity including seizures, altered mental status, and metabolic acidosis.
Conclusion Hemodialysis and renal replacement therapy may correct the acid base disturbance and provide support in cases of renal impairment in context of naproxen overdose, but further studies are needed to determine the extraction of naproxen.
Keywords Naproxen . Seizure . Metabolic acidosis . Hemodialysis
Introduction
Naproxen is a propionic acid type of nonsteroidal anti-inflammatory agent with analgesic, antipyretic, and anti-inflammatory properties. Despite being FDA approved in 1994 for over-the-counter use, naproxen is still not commonly reported among overdoses compared to other analgesics [1]. Naproxen is extensively protein bound to plasma proteins, primarily to albumin and to smaller degree globulins. Protein binding is 99.6 % with plasma concentrations between 23 and 40 mg/L, but as naproxen concentrations increase, protein binding declines, resulting in a higher fraction of unbound drug [2] allowing for possible removal by renal replacement therapy in massive poisonings accompanied by high levels. There are no previous reports on the effect of renal replacement therapy on naproxen levels. We report the first case of massive naproxen overdose (70 g) suffering serious toxicity with documented serial serum levels.
Case Report
A 28-year-old male with a past history...