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Serious toxicity in a young child due to ibuprofen
Insights
A toddler experienced a seizure and metabolic acidosis after ingesting a large amount of ibuprofen (600 mg/kg). Early seizures are a rare, serious sign of ibuprofen toxicity, even with treatment.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Toxicology
Background:
- Ibuprofen is a common over-the-counter nonsteroidal anti-inflammatory drug (NSAID) used for pain and fever.
- Overdose can lead to serious toxicity, including metabolic acidosis.
Observation:
- An 18-month-old male presented with lethargy and apnea after ingesting approximately 7.2 grams of ibuprofen.
- The patient experienced a tonic-clonic seizure and presented with metabolic acidosis.
Findings:
- Serum ibuprofen levels were significantly elevated at 640 microg/mL at 4 hours post-ingestion.
- Metabolic acidosis is common in ibuprofen doses >400 mg/kg, but early seizures are rarely reported.
- The patient improved with treatment and was extubated the following day.
Implications:
- This case highlights the potential for early seizures as a rare but critical sign of severe ibuprofen toxicity in children.
- Clinicians should consider early neurological symptoms in the context of significant ibuprofen ingestion.
- Prompt recognition and management are crucial for favorable outcomes in pediatric ibuprofen overdose.
Abstract:
An 18-month-old male presented to the emergency department (ED) for evaluation of lethargy and apnea. Four hours before presentation, the patient was found with an empty bottle of ibuprofen, an ingestion of as much as 7.2 grams (600 mg/kg). The ED course was remarkable for a 30-second tonic-clonic seizure. Laboratory analysis was notable for metabolic acidosis. Four-hour and 7.5-hour serum ibuprofen levels were 640 and 39 microg/mL, respectively. Following treatment, the patient improved and was extubated the next morning. While metabolic acidosis has been frequently described at doses exceeding 400 mg/kg, seizures occurring early in the course of ibuprofen toxicity have been rarely noted.