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

Thammineni, Nikhila; Kathi, Pradeep; Sharma, Aditi; Jawed, Areeba

doi:10.7759/cureus.6404

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…For the final analysis, we retained 41 scientific reports published since 1985: 22 from America (United States of America, N = 20; Canada, N = 1; Mexico, N = 1), 12 from Europe (United Kingdom, N = 9; Germany, N = 2; Spain, N = 1), 6 from Australia, and 1 from Asia (Saudi Arabia, N = 1). 2,8-47 Thirty-nine articles were published in English, 1 in Spanish, and 1 in German. The mentioned reports described 50 cases (14 children and 36 adults).…”

Section: Resultsmentioning

confidence: 99%

“…In addition to ibuprofen (Table 1), various drugs had been administered in 28 cases. 11-13,22-24,26,29-40,42,43,45…”

Section: Demographics Clinical and Laboratory Featuresmentioning

confidence: 99%

“…The remaining 24 cases were considered long term. 18,22,24,28,[32][33][34][35][36]38,39,41,42,[44][45][46][47] Twenty-two cases were observed after ingestion of ibuprofen 40 mg/kg body weight or less daily (N = 5), 41 to 100 mg/kg body weight daily (N = 6), or >100 mg/kg body weight daily (N = 11). The duration of ingestion was 2 weeks (N = 1), 1 to 3 months (N = 8), 4 to 12 months (N = 7), more than 12 months (N = 3) and unspecified (but more than 2 weeks) in 3 cases.…”

Section: Dosage-acute and Long-term Ingestionmentioning

confidence: 99%

“…In addition to ibuprofen (Table 1), various drugs had been administered in 28 cases. [11][12][13][22][23][24]26,[29][30][31][32][33][34][35][36][37][38][39][40]42,43,45 The renal tubular handling of potassium or acid-base balance was investigated in 19 cases. The urinary findings were consistent with an altered renal tubular function were noted in 14 of them (Table 2).…”

Section: Demographics Clinical and Laboratory Featuresmentioning

confidence: 99%

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Ibuprofen-Associated Hypokalemia and Metabolic Acidosis: Systematic Literature Review

et al. 2022

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Objective: Ibuprofen is a widely used nonsteroidal anti-inflammatory drug, which has been occasionally associated with hypokalemia and metabolic acidosis. The objective of this report is to analyze the literature on this issue and to address the underlying pathophysiology. Data Sources: Excerpta Medica, the National Library of Medicine, and Web of Science were searched from inception to July 16, 2021. Study Selection and Data Extraction: Papers reporting individually documented humans on ibuprofen with hypokalemia, acidosis, or both were retained. Data were extracted using a checklist. Data synthesis: For the final analysis, we evaluated 41 reports describing 50 cases (26 males and 24 females; 36 adults and 14 children) with often profound hypokalemia, acidosis, or both after ingestion of ibuprofen. Twenty-six cases were acute and 24 long term. Hypokalemia and acidosis occurred not only after ingestion of very high doses but also after ingestion of moderately high or even normal doses of ibuprofen. Laboratory values consistent with an excessive urinary potassium excretion or an altered urinary acidification were often disclosed in most cases. Discontinuation of ibuprofen resulted in a resolution of hypokalemia and acidosis within days in 47 cases. The course was lethal in 3 cases. Relevance to Patient Care and Clinical Practice: This review highlights potentially fatal side effects of ibuprofen and can help doctors who are confronted with such a situation. Conclusions: These data highlight the potential of ibuprofen to occasionally induce hypokalemia and acidosis of renal origin. Discontinuation of ibuprofen results in a resolution within days.

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