Ibuprofen-induced renal tubular acidosis—a rare cause of rhabdomyolysis: a case report

Dang, Minh Huan; Wu, Samuel M.; Sia, Christopher

doi:10.1093/omcr/omw057

Cited by 5 publications

(10 citation statements)

References 10 publications

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“…This leads to higher sodium levels in the distal tubule, which results in secondary hyperaldosteronism and augmented potassium excretion by the kidneys 9. Furthermore, serum hypokalaemia causes vasoconstriction in muscles and promotes muscle necrosis, resulting in rhabdomyolysis 15. Our patient demonstrated many of the key biochemical findings expected in RTA; hypokalaemia and a normal anion gap metabolic acidosis as well as an elevated CK suggesting hypokalaemia-induced rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 64%

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Hasan

Armstrong

et al. 2019

BMJ Case Rep

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Ibuprofen-induced renal tubular acidosis is a rare but important diagnosis which should be considered in patients presenting with hypokalaemia and metabolic acidosis. This case report details the case of a 33-year-old woman presenting with reduced conscious state, metabolic acidosis and profound hypokalaemia without an obvious cause. With correction of the patient’s electrolyte and acid-base disturbance, her conscious state improved allowing disclosure of her use of Nurofen Plus for its euphoric opiate effects. The diagnosis of renal tubular acidosis had been considered and subsequent disclosure of excessive chronic ingestion of ibuprofen suggested this to be the underlying cause. The striking feature of our patient was the insidious development of the problem and delayed accurate drug history. An important safety message arising from our case is the composite risk of dependence on the opiate component of over the counter analgesics, such as Nurofen Plus, and adverse events related to the ibuprofen component.

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Section: Discussionmentioning

confidence: 64%

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Hasan

Armstrong

et al. 2019

BMJ Case Rep

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“…Ibuprofen-induced RTA has been hypothesized to be secondary to the inhibition of carbonic anhydrase inhibitor (CA) II, which is widely distributed throughout the nephron [3]. It has been shown to cause both proximal and distal RTA, as seen in the previously documented cases [4][5].…”

Section: Discussionmentioning

confidence: 99%

“…A PubMed search showed only 16 cases of ibuprofen-induced hypokalemia and RTA as mentioned in Table 2 [1][2][3][4][5][6][7][8][9][10][11][12][13]. The majority of the patients were females (10) The most prominent abnormalities seen in our patients are hypokalemia, metabolic acidosis likely secondary to proximal RTA, with a negative urinary anion gap in patient 1, and distal RTA, with a positive urinary anion gap in patient 2, and alkaline urine pH in the setting of ibuprofen overuse.…”

Section: Discussionmentioning

confidence: 99%

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Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients

Thammineni

Kathi

Sharma

et al. 2019

Cureus

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Ibuprofen is a commonly used medication in the United States and is used both by prescription and over the counter, while hypokalemia is a life-threatening condition caused by various etiologies, one of which is the side effect of medications. Ibuprofen is well-known for its various nephrotoxic side effects, including hyperkalemia as a common electrolyte abnormality, however, renal tubular acidosis leading to hypokalemia with the use of ibuprofen has been reported rarely. We present here two cases of life-threatening hypokalemia due to over-thecounter use of large doses of ibuprofen and describe its management.

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“…Less frequent adverse effects linked with supratherapeutic ibuprofen use include renal tubular acidosis, life‐threatening hypokalaemia (with risk of fatal cardiac arrhythmia), and rhabdomyolysis . The prevalence of mental health problems in patients experiencing these conditions is high.…”

mentioning

confidence: 99%

From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

Dobbin

2020

Medical Journal of Australia

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2 Schaffer AL, Cairns R, Brown J, et al. Changes in pharmaceutical sales to pharmacies after codeine was rescheduled a prescription only medicine. Med J Aust 2020; 212: 321-327. 3 Harris K, Jiang A, Knoeckel R, Isoardi KZ. Rescheduling codeine-containing analgesics reduced codeine-related hospital presentations. Med J Aust 2020; 212: 328. 4 Degenhardt L, Gisev N, Cama M, et al. The extent and correlates of community-based pharmaceutical opioid utilisation in Australia. Pharmacoepidemiol Drug Saf 2016; 25: 521-538. 5 Annabel B, Scrymgeour M. Fork handles. Australas J Pharm 2017; 98: 74-75. 6 McAllister WB. The global political economy of scheduling: the international-historical context of the Controlled Substances Act. Drug Alcohol Depend 2014; 76: 3-8. 7 Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev 2015; CD010107. 8 Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallelgroup, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain 2011; 152: 632-642. 9 Cock V, Edmonds C, Cock C. Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal. Drug Alcohol Rev 2018; 37: 731-737. 10 Frei MY, Nielsen S, Dobbin MDH, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296. https://www.mja.com.au/journ al/2010/193/5/serio us-morbi dity-assoc iated-misuse-over-count er-codei neibupr ofen-analg esics 11 Mill D, Johnson JL, Cock V, et al. Counting the cost of over-the-counter codeine containing analgesic misuse: a retrospective review of hospital admissions over a 5 year period. Drug Alcohol Rev 2018; 37: 247-256.

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Ibuprofen-induced renal tubular acidosis—a rare cause of rhabdomyolysis: a case report

Cited by 5 publications

References 10 publications

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Impaired consciousness, hypokalaemia and renal tubular acidosis in sustained Nurofen Plus abuse

Ibuprofen Overuse Leading to Life-threatening Hypokalemia Associated with Renal Tubular Acidosis in Two Patients

From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

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