What is Nonsteroidal Anti-Inflammatory Drugs Toxicity?
Nonsteroidal anti-inflammatory drugs, often shortened to NSAIDs, are a group of medications with different chemical compositions but similar treatment effects and side effects. These drugs work by reducing inflammation, pain, and fever by blocking enzymes called cyclooxygenase (COX) that help create inflammation.
There are two types of these COX enzymes: COX-1 and COX-2. Both convert a fat called arachidonic acid into other compounds known as endoperoxides, which have a variety of functions in our bodies such as causing inflammation, regulating muscle tone, and blood clotting.
COX-1 is made continuously by our bodies and is the main source of compounds required for maintaining a stable internal environment, like protecting the inner lining of our stomachs. Conversely, COX-2 is only produced during certain situations, like in response to stress or inflammation, and its compounds significantly increase under these circumstances.
Although COX-1 and COX-2 have distinct roles, they can work together and both contribute during the development of an inflammatory response.
What Causes Nonsteroidal Anti-Inflammatory Drugs Toxicity?
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which are mainly derived from organic acids, are quickly absorbed through the stomach and intestines. These drugs undertake a complex change in the liver and are finally expelled from our body through a process involving our kidneys. Hence, people with severe liver and kidney diseases should generally avoid these drugs.
NSAIDs bind mostly to substances called plasma proteins found in our blood. Because of this, they can quickly gather at sites where inflammation is occurring, such as an injury or a disease area. So, these drugs are known to provide pain relief quite fast, usually within 30 to 60 minutes.
Risk Factors and Frequency for Nonsteroidal Anti-Inflammatory Drugs Toxicity
Non-steroidal anti-inflammatory drugs, or NSAIDs, are commonly used for relieving pain and reducing fever. These drugs are available both over-the-counter and by prescription. In the United States, it is estimated that 14 million adults aged 45 and older use these drugs regularly. With the population getting older, the US Centers for Disease Control and Prevention (CDC) expects the use of NSAIDs to rise. This increase is anticipated to come with more common painful conditions like osteoarthritis and inflammatory diseases. As a result, the number of adverse effects related to NSAIDs might also increase. Previous research has shown that drug toxicity contributes to 5% to 7% of hospital admissions, with non-aspirin NSAIDs accounting for 11% to 12% of those cases.
Signs and Symptoms of Nonsteroidal Anti-Inflammatory Drugs Toxicity
When doctors are checking for possible medication side effects, they need to know several details. These include the type of drug taken, how much was consumed, and when it was taken. They also need to know about any other substances the person may have taken as this can help figure out if there are any dangerous overdoses or drug interactions. Physical signs aren’t usually evident apart from a quick change in the patient’s mental state. However, they may report stomach issues like nausea and vomiting, feel dizzy, sleepy or have blurred vision. But a person’s medical history can heavily impact how the drug can affect the person. That’s why it’s very important for healthcare providers to carefully collect all this information, as it may show risk factors or other health conditions that could affect how the drug interacts.
- Type of drug taken
- Amount of drug consumed
- Time drug was taken
- Any other substances taken
- Change in mental status
- Stomach upset (nausea and vomiting)
- Dizziness
- Sleepiness
- Blurred vision
- Patient’s medical history
Testing for Nonsteroidal Anti-Inflammatory Drugs Toxicity
If your doctor suspects that you may have taken too many Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), they will first take a history (ask you questions about what you took, when and why), and perform a physical examination. After this, they will conduct some laboratory tests to measure levels of common medications that people often take alongside NSAIDs, like acetaminophen and salicylate.
Additional tests might vary based on your symptoms. For example, if you’ve taken a lot of the drug (over 6 grams if you’re an adult or more than 400 milligrams per kilogram of body weight if you’re a child), the doctor might want to check your kidney function. They can do this by testing your blood urea nitrogen, creatinine, and electrolyte levels.
If the NSAIDs have caused bleeding, a complete blood count can be done to check your levels of hemoglobin (the protein in red blood cells that carries oxygen) and platelets (blood cells that help your body form clots to stop bleeding).
If you’ve possibly ingested a massive amount of drugs, an arterial blood gas test might be done. This test measures the levels of certain gases in your blood and can show if your body is maintaining the correct balance of acid and base. An electrocardiogram (ECG) might also be done. This test measures the electrical activity of your heart and can show if the interval of time between certain heartbeats (known as the QT interval) has been affected by the drugs you took.
Finally, the doctor might conduct additional tests to check for other possible causes of any mental confusion or unusual behavior you may be experiencing, such as low blood sugar (hypoglycemia).
Treatment Options for Nonsteroidal Anti-Inflammatory Drugs Toxicity
For patients who have taken too many nonsteroidal anti-inflammatory drugs (NSAIDs) and are suffering from their side effects, which we refer to as acute NSAID poisoning, the first step doctors take is to check their airway, breathing, and circulation. Concretely, this means ensuring the patient is stable and that the vital functions, like breathing and heart rhythm, are not in danger.
The doctor will also seek to find out the time of ingestion, or in other words, when the patient took the drugs. This is important in determining the best course of action to remove the drug from the patient’s body – for instance, if the patient arrived at the hospital within two hours of taking the drugs, doctors might decide to use activated charcoal. This substance can help absorb the drugs in the stomach and intestines, preventing further absorption into the body. However, activated charcoal isn’t suited for all situations and can’t be used if the patient has certain conditions.
In spite of a lot of research, there is no specific antidote for acute NSAID toxicity. The main approach is supportive care. In simpler terms, this means managing the symptoms resulting from the overdose and returning the patient’s body functions back to normal. In some cases, this might involve correcting electrolyte disturbances (a balance of minerals in your body), restoring an adequate amount of fluid in the body’s blood vessels, or dealing with acid-base disorders, which is when the balance of acid and base in your body’s fluids is off.
For patients who have been exposed to NSAIDs for a long time, and who are experiencing negative effects, the goal is to reduce or, if possible, eliminate the amount of these drugs they are taking. This would help avoid further negative impacts of the drugs on their body.
What else can Nonsteroidal Anti-Inflammatory Drugs Toxicity be?
Here are some medical conditions to be aware of:
- Abdominal pain in elderly patients
- Acute lactic acidosis
- Anxiety disorders
- Chronic anemia
- Delirium, dementia, and amnesia in emergency medicine
- Encephalitis
- Peptic ulcer disease
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
