Drug points: Mefenamic acid nephropathy--acute renal failure in overdose

Turnbull, A. J.; Campbell, P. S.; Hughes, John A.

doi:10.1136/bmj.296.6622.646

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…The patient recovered with conservative therapy (Turnbull et al 1988). Initially there was restlessness and agitation, which progressed to generalised tonicclonic convulsions.…”

Section: Case Reportmentioning

confidence: 90%

“…In the Gossinger case, a 13year-old patient ingested 5 to 109 and became unconscious within 1.5 hours but did not experience seizures until later. Grand mal seizures were seen in a case reported by Gossinger et al (1982), and following ingestion of 12.5g by a 30year-old male (Turnbull et al 1988). Irritability, restlessness and agitation may lead to seizures (Balai-Mood et al 1981).…”

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 95%

“…(1982) and Turnbull et at. Coma or a depressed level of consciousness was noted in cases of mefenamic acid overdose reported by Gossinger et at.…”

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 96%

“…After I week, the serum creatinine had fallen to 221 mmol/L (Turnbull et al 1988). Acute renal failure, first evidenced by a rising serum creatinine level 24 hours after ingestion of mefenamic acid, was reported in a 30-yearold man who ingested 12.5g in a single dose.…”

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 99%

“…Seizures and acute renal failure have been noted with ingestion of as little as 7.5g (Court & Volans 1984;Turnbull et al 1988;Young 1979). Seizures and acute renal failure have been noted with ingestion of as little as 7.5g (Court & Volans 1984;Turnbull et al 1988;Young 1979).…”

Section: Dose-response Relationshipmentioning

confidence: 99%

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Toxic Effects of Nonsteroidal Anti-Inflammatory Drugs in Overdose

et al. 1990

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Nonsalicylate, nonsteroidal anti-inflammatory drugs (NSAIDs) can be divided into 4 chemical classes: acetic acids, fenamic acids, oxicams and propionic acids. Most NSAID overdoses result in a benign outcome. Of 50,614 exposures reported to poison centres in the United States in a 2-year period, 131 (0.26%) had a major outcome, with 10 deaths. Despite the generally mild effects reported in large patient series, isolated case reports have documented serious toxicity, such as seizures, hypotension, apnoea, coma and renal failure. The majority of these consequences occur after ingestion of substantial quantities by adults attempting suicide. Rarely, with ibuprofen and piroxicam, children who ingest small amounts in accidental exposure develop serious toxicity. Typical signs and symptoms of NSAID overdose include nausea, vomiting, headache, drowsiness, blurred vision and dizziness. Seizures are rarely documented across all NSAID classes, with the exception of mefenamic acid (where seizures occur in over one-third of cases), or following massive ingestion of other agents. Drugs in the propionic acid group have produced metabolic acidosis, respiratory depression and coma in severe cases. Ibuprofen is the agent with the most published data on overdose, probably because it is available without a prescription in many countries. Symptoms are unlikely after ingestion of 100 mg/kg or less, and are usually not life-threatening unless more than 400 mg/kg is ingested. There is some relationship between plasma concentrations and the potential for development of symptoms, but plasma concentrations have no impact on treatment decisions. Treatment of NSAID overdose is entirely supportive. Recent trends in emergency department procedures regarding gastric decontamination are evolving towards the recommended administration of activated charcoal without gastric emptying in patients presenting more than 1 hour after ingestion, although gastric lavage, followed by administration of activated charcoal, may be advisable in patients who present earlier. Home administration of syrup of ipecac is still recommended if treatment is given shortly after ingestion, with a few exceptions: for example, ipecac is contraindicated after ingestion of mefenamic acid or ibuprofen in amounts greater than 400 mg/kg. Urine alkalinisation and diuresis have been recommended to enhance the elimination of NSAIDs, based on a pKa in the range of 3 to 5. However, because the drugs are universally highly protein bound, with little unchanged renal excretion, this technique is not likely to be beneficial. Haemodialysis is also unlikely to enhance elimination, but may be required if oliguric renal failure develops. Multiple dose activated charcoal may be useful in enhancing elimination of NSAIDs with long half-lives, such as piroxicam and sulindac.

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“…The patient recovered with conservative therapy (Turnbull et al 1988). Initially there was restlessness and agitation, which progressed to generalised tonicclonic convulsions.…”

Section: Case Reportmentioning

confidence: 90%

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 95%

“…(1982) and Turnbull et at. Coma or a depressed level of consciousness was noted in cases of mefenamic acid overdose reported by Gossinger et at.…”

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 96%

Section: Cardiovascular a 34-year-old-man Ingested Atmentioning

confidence: 99%