Ibuprofen poisoning in children and adolescents
- Frederick M Henretig, MD
Frederick M Henretig, MD
- Professor Emeritus of Pediatrics and Emergency Medicine
- Perelman School of Medicine, University of Pennsylvania
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The evaluation and management of acute overdose of ibuprofen in children and adolescents is reviewed here.
The management of acute overdose of nonsteroidal antiinflammatory drugs, including ibuprofen, in adults and the chronic toxicity of NSAIDs is discussed separately. (See "Nonsteroidal antiinflammatory drug (NSAID) poisoning" and "Nonselective NSAIDs: Overview of adverse effects".)
Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that has been available as an over-the-counter preparation since 1984 . Based upon reports to the American Association of Poison Control Centers’ National Poison Data System, ibuprofen as a single substance accounts for approximately 50,000 exposures in children and adolescents annually, with the majority of reports occurring in children under six years of age . Major effects or death from ibuprofen poisoning is rare. (See "Nonsteroidal antiinflammatory drug (NSAID) poisoning".)
Ibuprofen is a propionic acid derivative. Like other nonsteroidal antiinflammatory drugs (NSAIDs), it inhibits cyclooxygenase (prostaglandin synthase), thereby impairing the ultimate transformation of arachidonic acid to prostaglandins, prostacyclin, and thromboxanes (figure 1). Ibuprofen has analgesic, antipyretic, antiinflammatory, and uterine muscle effects that largely are mediated by reduced prostaglandin synthesis although other mechanisms of action are proposed. (See "NSAIDs: Mechanism of action".)
●Pharmacokinetics – The pharmacokinetics of ibuprofen are as follows (see "Nonsteroidal antiinflammatory drug (NSAID) poisoning", section on 'Kinetics'):
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- CLINICAL FEATURES OF ACUTE OVERDOSE
- ANCILLARY STUDIES
- - Coma, apnea, and hypotension
- - Seizures
- - Metabolic acidosis
- - Vomiting and gastritis
- Gastrointestinal decontamination
- Elimination enhancement
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS