Fatality after deliberate ingestion of sustained-release ibuprofen: a case report.

INTRODUCTION: Ibuprofen is a nonsteroidal anti-inflammatory drug available over the counter and on prescription for the management of pain and inflammation. Severe toxicity is rare following deliberate self-poisoning with ibuprofen, and patients are usually either asymptomatic or develop only mild gastrointestinal toxicity. Although there have been nine other reported fatalities, co-existent factors have probably contributed to all of these deaths. We report here a fatality from isolated toxicity following self-poisoning with sustained-release ibuprofen. CASE REPORT: A 26-year-old female presented after deliberate ingestion of up to 105 g sustained-release ibuprofen, with a reduced level of consciousness, severe metabolic acidosis and haemodynamic compromise. Despite intensive supportive management, gut decontamination with multidose activated charcoal and correction of the metabolic acidosis with sodium bicarbonate and haemofiltration, the patient did not survive. The ibuprofen concentration ante mortem on presentation in peripheral blood was 760 mg/l and the concentrations post mortem were 518 mg/l in peripheral blood, 74 mg/kg in liver extract and 116 mg/l in the gastric contents. DISCUSSION: Most patients with ibuprofen poisoning are either asymptomatic or have mild gastrointestinal symptoms; severe poisoning with ibuprofen is rare. We report the first death related to isolated sustained-release ibuprofen poisoning.

Ibuprofen overdose.

Enquiries about the management of patients possibly suffering from ibuprofen overdose account for over 5% of the total enquiry workload of the London Centre of the United Kingdom National Poisons Information Service. Unlike overdose with aspirin and paracetamol, no additional pathophysiological findings have been reported in ibuprofen overdose and all the demonstrated toxic effects relate to its known pharmacological actions and the effects of accumulation of the two acidic metabolites, 2-hydroxyibuprofen and 2-carboxylibuprofen. The most striking finding in reported cases is that the great majority of patients suffer no or only mild symptoms. In one series of 1,033 enquiries involving ingestion of ibuprofen alone, 705 (65%) patients were asymptomatic; 199 (18%) experienced mild symptoms; and 23 (2%) experienced moderate symptoms. We are aware of only seven case reports of fatal overdose with ibuprofen and in each case there are complicating factors related to other drugs and/or other disease processes. The management of ibuprofen overdose is generally straightforward and can be related to the dose ingested. Initial findings suggest even less evidence for toxicity associated with modified release formulations than with the conventional tablets. There is at present no reason to be concerned that co-ingestion of ethanol increases the risk of toxicity from ibuprofen overdose. Ibuprofen overdose is common but serious toxic effects are unusual and guidelines for treatment are straightforward.