Massive Naproxen Overdose with Serial Serum Levels

Abstract

Context 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 25-75 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.

Graphene-Oxide-Based Electrochemical Sensors for the Sensitive Detection of Pharmaceutical Drug Naproxen

“…In addition, the proposed GO-based electrochemical sensor was tested using actual pharmaceutical naproxen tablets without pretreatments, further demonstrating excellent sensitivity and selectivity. Moreover, this study provided insights into the participatory catalytic roles of the oxygen functional groups of the GO-based nanomaterials toward the electrochemical oxidation and sensing of naproxen.using an oral immediate release tablet is 550 mg, followed by 275 mg orally every 6 to 8 hours, or 550 mg every 12 hours as needed, which should not exceed 1375 mg/day [3][4][5]. Cases of naproxen overdose include serious toxicity with seizures, altered cognitive status, and metabolic acidosis.…”

“…using an oral immediate release tablet is 550 mg, followed by 275 mg orally every 6 to 8 hours, or 550 mg every 12 hours as needed, which should not exceed 1375 mg/day [3][4][5]. Cases of naproxen overdose include serious toxicity with seizures, altered cognitive status, and metabolic acidosis.…”

Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

“…Another combination of naproxen, acetaminophen pregabalin with or without adding other analgesics like thiocolchicoside or tizanidine or tramadol showed sub-optimal pain control with GIT, cardiovascular (CVS), and CNS toxicity like hypotension, headache, anorexia, dysphagia, constipation, oral ulcers, diarrhea, weakness, cough etc. Similar reports are available on tramadol and naproxen toxicity and sub-optimal pain control on opioid use [20][21][22][23][24][25][26][27]. In addition to the above analgesic combinations, acetaminophen and orphenadrine including or not tramadol showed suboptimal pain control with toxicity like hypotension, hypertension, dyspnea, sweating, dysuria, anorexia, depression, etc.…”

Pharmacogenetic Analysis of an 8-Year Old Girl with Reye Syndrome Associated with Use of Naproxen

“…Other inborn errors of metabolism were further ruled out by additional diagnostic workup. Since the incidence of Reye syndrome is known to be associated with the administered dose of aspirin, and similar symptoms (drowsiness, metabolic acidosis, seizure activity, renal impairment, and hepatotoxicity) were reported in naproxen intoxication cases, the possibility of naproxen overdose was investigated [ 16 , 17 ]. While the patient received a higher than usual recommended dose of naproxen (5 mg/kg/day) of 22 mg/kg/day, the difference was marginal.…”