Reactions 1464, p25 - 10 Aug 2013 O S Ibuprofen overdose Syndrome of inappropriate diuresis: case report A 30-year-old woman developed syndrome of inappropriate diuresis after an overdose of ibuprofen. The woman was admitted to an emergency department with fever and nausea. Blood tests showed a moderate hyponatraemia (132 mmol/L), while other biological values were within the normal ranges. The following day she complained of headache, nausea and diffuse pain similar to meningism. An EEG revealed signs of encephalopathy, and biochemistry tests showed a serum sodium level of 113 mmol/L, and an osmolality of 239 mOsm/L. The woman was administered normal saline and presumptive anti-infective treatment with amoxicillin, aciclovir and ceftriaxone. She experienced a seizure, and was moved to the ICU. Her serum sodium level fell to 105 mmol/L on day 3. Fluid restriction was initiated, and in 24 hours her serum sodium had risen to 124 mmol/L. However, while her neurological disorders were abating, she developed acute renal failure, necessitating withdrawal of fluid restriction. On day 6, her renal function was restored, and her serum sodium level had reached 132 mmol/L. Additional investigations uncovered the fact that she had ingested more than 20 tablets of ibuprofen 400mg (representing 152 mg/kg) to treat back pain 2 days prior to admission. She was discharged 12 days later after achieving a favourable outcome. Author comment: "Ibuprofen-induced [syndrome of inappropriate diuresis] was the most likely diagnosis. . . [T]he score was five [using Naranjo criteria], so the adverse drug reaction was classified as probable". Roche C, et al. Ibuprofen can induce syndrome of inappropriate diuresis in healthy young patients. Case Reports in Medicine 2013: No. 167267, 2013. Available from: URL: http://dx.doi.org/10.1155/2013/167267 - France 803091259 1 Reactions 10 Aug 2013 No. 1464 0114-9954/13/1464-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved

Ibuprofen overdose

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Reactions 1464, p25 - 10 Aug 2013

O SIbuprofen overdose

Syndrome of inappropriate diuresis: case reportA 30-year-old woman developed syndrome of inappropriate

diuresis after an overdose of ibuprofen.The woman was admitted to an emergency department with

fever and nausea. Blood tests showed a moderatehyponatraemia (132 mmol/L), while other biological valueswere within the normal ranges. The following day shecomplained of headache, nausea and diffuse pain similar tomeningism. An EEG revealed signs of encephalopathy, andbiochemistry tests showed a serum sodium level of113 mmol/L, and an osmolality of 239 mOsm/L.

The woman was administered normal saline andpresumptive anti-infective treatment with amoxicillin, aciclovirand ceftriaxone. She experienced a seizure, and was moved tothe ICU. Her serum sodium level fell to 105 mmol/L on day 3.Fluid restriction was initiated, and in 24 hours her serumsodium had risen to 124 mmol/L. However, while herneurological disorders were abating, she developed acuterenal failure, necessitating withdrawal of fluid restriction. Onday 6, her renal function was restored, and her serum sodiumlevel had reached 132 mmol/L. Additional investigationsuncovered the fact that she had ingested more than 20 tabletsof ibuprofen 400mg (representing 152 mg/kg) to treat backpain 2 days prior to admission. She was discharged 12 dayslater after achieving a favourable outcome.

Author comment: "Ibuprofen-induced [syndrome ofinappropriate diuresis] was the most likely diagnosis. . . [T]hescore was five [using Naranjo criteria], so the adverse drugreaction was classified as probable".Roche C, et al. Ibuprofen can induce syndrome of inappropriate diuresis in healthyyoung patients. Case Reports in Medicine 2013: No. 167267, 2013. Availablefrom: URL: http://dx.doi.org/10.1155/2013/167267 - France 803091259