title: Massive ibuprofen overdose requiring extracorporeal membrane oxygenation for cardiovascular support.
abstract: OBJECTIVE
  Ibuprofen is rarely associated with severe toxicity. We report a massive ibuprofen overdose that resulted in refractory hypotension requiring extracorporeal membrane oxygenation (ECMO) for cardiovascular support.
  
  
  METHODS
  Individual case report.
  
  
  METHODS
  Pediatric intensive care unit of a tertiary care hospital.
  
  
  METHODS
  A 14-yr-old male presented with apnea and cardiovascular collapse after a nonaccidental ingestion of approximately 50 g of ibuprofen. His laboratory evaluation demonstrated an anion gap metabolic acidosis and elevated lactate levels.
  
  
  METHODS
  The patient required pressor support with norepinephrine, phenylephrine, and vasopressin infusions. Due to refractory hypotension, he was placed on ECMO. His serum ibuprofen level at an estimated 5-10 hrs postingestion was 776 microg/mL (therapeutic 20-30 microg/mL). Urine toxicological screen for drugs of abuse, serum acetaminophen, salicylate, and carboxyhemoglobin levels showed that these levels were not elevated. The patient developed high-output renal failure, pulmonary hemorrhage, and gastric bleeding, all of which resolved by hospital day 3.
  
  
  RESULTS
  ECMO was discontinued on hospital day 4, inotropic support was discontinued, and the patient was extubated on hospital day 5. He was transferred to an inpatient psychiatric unit on hospital day 9 with no identifiable medical sequelae.
  
  
  CONCLUSIONS
  Although ibuprofen overdose typically has few consequences, severe hypotension, renal failure, and gastrointestinal bleeding can occur. We report the first known case of successful ECMO therapy for ibuprofen overdose.
authors.affiliation: University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Kira E
authors.initials: KE
authors.lastname: Marciniak
authors.forename: Ildiko H
authors.initials: IH
authors.lastname: Thomas
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Joan S
authors.initials: JS
authors.lastname: Roberts
authors.forename: Angela
authors.initials: A
authors.lastname: Czaja
authors.forename: Suzan S
authors.initials: SS
authors.lastname: Mazor
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007052:Ibuprofen / Q000506:poisoning*; D008297:Male; D013406:Suicide, Attempted
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen