What is the likely clinical course for a 28-year-old, 215-pound male patient who ingested 2000mg of ibuprofen (Nonsteroidal Anti-Inflammatory Drug, NSAID)?

From the Guidelines

A 28-year-old, 215lb male who ingested 2000mg of ibuprofen is likely to experience minimal to no significant toxicity. This dose, while higher than the standard single dose of 400-800mg, remains within the therapeutic range for a person of this weight. The patient may experience mild gastrointestinal symptoms such as nausea, stomach pain, or heartburn, as NSAIDs are known to increase the risk of GI complications, with an average relative risk of 5-6 fold that of those not taking NSAIDs 1. However, given the patient's age and the dose ingested, the risk of severe GI complications is low, as advancing age is associated with an increased risk, and this patient is relatively young 1. The patient should be advised to avoid taking additional NSAIDs for at least 6 hours and to seek medical attention if unusual symptoms develop, such as severe gastrointestinal distress, metabolic acidosis, renal dysfunction, or CNS effects. Key factors to consider in this patient's management include:

• Monitoring for signs of GI toxicity, such as bleeding or ulceration
• Advising the patient to take the medication with food and adequate hydration to minimize GI symptoms
• Avoiding concomitant use of other NSAIDs, corticosteroids, or anticoagulants, which can increase the risk of GI complications 1
• Educating the patient on the risks of NSAID use and the importance of following recommended dosing guidelines.

From the FDA Drug Label

Approximately 1½ hours after the reported ingestion of from 7 to 10 ibuprofen tablets (400 mg), a 19-month old child weighing 12 kg was seen in the hospital emergency room, apneic and cyanotic, responding only to painful stimuli. In two other reported cases where children (each weighing approximately 10 kg) accidentally, acutely ingested approximately 120 mg/kg, there were no signs of acute intoxication or late sequelae A 19-year old male who had taken 8,000 mg of ibuprofen over a period of a few hours complained of dizziness, and nystagmus was noted.

The patient ingested 2000mg of ibuprofen, which is less than the 8000mg ingested by the 19-year-old male in the report. However, the patient's weight and the time frame of ingestion are different.

• The likely clinical course may include dizziness and nystagmus, as seen in the 19-year-old male who ingested a larger dose.
• Supportive measures and monitoring are recommended, as the patient may experience adverse effects.
• The use of oral activated charcoal may help to reduce the absorption and reabsorption of ibuprofen tablets 2.

From the Research

Clinical Course of Ibuprofen Overdose

The clinical course of a 28-year-old, 215lb male patient who ingested 2000mg of ibuprofen can be variable, as evidenced by several studies 3, 4, 5, 6, 7.

• The majority of patients who overdose on ibuprofen experience no symptoms or only mild gastrointestinal or central nervous system manifestations 5.
• However, serious toxicity may occur, and it is difficult to predict which patients will be affected 3.
• Possible complications of ibuprofen overdose include metabolic acidosis, adult respiratory distress syndrome, and renal failure 3, 6.
• In some cases, patients may develop shock, coma, and severe metabolic acidosis, especially if they ingest a large quantity of ibuprofen 4, 6.
• The management of ibuprofen overdose is generally straightforward and can be related to the dose ingested 5.
• Treatment may involve supportive care, such as fluid resuscitation, and decontamination with activated charcoal 4.
• The prognosis for patients who overdose on ibuprofen is generally good, with most patients recovering without any clinical sequelae 4, 5, 6.

Factors Influencing Clinical Course

Several factors can influence the clinical course of ibuprofen overdose, including:

• The dose of ibuprofen ingested: higher doses are associated with a greater risk of serious toxicity 5, 6.
• The presence of underlying medical conditions: patients with pre-existing medical conditions may be more susceptible to the toxic effects of ibuprofen 3, 6.
• The timing of treatment: early and aggressive intervention can improve outcomes in patients who overdose on ibuprofen 4.