Hypokalaemia and Renal Tubular Acidosis due to Abuse of Nurofen Plus

Abstract

Nurofen Plus is a common analgesic containing ibuprofen and codeine. We present a case of a 38-year-old lady who developed renal tubular acidosis with severe hypokalaemia, after chronic abuse of Nurofen Plus tablets. She presented with confusion and profound biochemical abnormalities requiring critical care admission for electrolyte replacement. Ibuprofen causes renal tubular acidosis due to its effects on carbonic anhydrase activity.

Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal

“…These complications are consistent with the available literature describing complications arising due to supratherapeutic use of ibuprofen/codeine compound analgesics [1,[3][4][5][6]. The increased number of complications demonstrated in the ibuprofen/codeine compound analgesic ingesting group is also likely related to the pharmacology of ibuprofen and the expected complications related to chronic supratherapeutic use of this pharmacological agent.…”

“…NSAID associated renal tubular acidosis [4][5][6] was also encountered more often in the group taking ibuprofen/codeine containing compound analgesics (18% of the ibuprofen/codeine group versus 4% of the paracetamol/codeine group). NSAID associated renal tubular acidosis [4][5][6] was also encountered more often in the group taking ibuprofen/codeine containing compound analgesics (18% of the ibuprofen/codeine group versus 4% of the paracetamol/codeine group).…”

“…[4,[9][10][11][12][13][14][15][16][17] The state hospital electronic health records of the patients who identified as codeine-dependent, and had presented for assistance with codeine withdrawal and dependence to the DASSA withdrawal service, were reviewed for episodes of care occurring in the same time period as the study time period-Feb 2009 to Feb 2014. [4,[9][10][11][12][13][14][15][16][17] The state hospital electronic health records of the patients who identified as codeine-dependent, and had presented for assistance with codeine withdrawal and dependence to the DASSA withdrawal service, were reviewed for episodes of care occurring in the same time period as the study time period-Feb 2009 to Feb 2014.…”

“…Complications occur in codeinedependent individuals due to co-formulation of codeine with paracetamol or ibuprofen. There is however evidence available documenting medical complications due to supratherapeutic ibuprofen/codeine containing compound analgesic use [1][2][3][4][5][6]. Complications arising due to chronic paracetamol use are less well understood and there is very little available evidence detailing complications due to the chronic supratherapeutic use of paracetamol/codeine containing compound analgesics.…”

“…• Renal tubular acidosis [4,13] and associated electrolyte disturbances; and • Hypoalbuminemia as result of non-steroidal antiinflammatory drug (NSAID)-induced nephrotic syndrome and/or gastrointestinal protein loss due to NSAID enteropathy [4,[9][10][11][12][13].…”