title: Acute kidney injury, hyperbilirubinemia, and ischemic skin necrosis due to massive sulindac overdose.
abstract: Sulindac is a long-acting nonsteroidal anti-inflammatory drug (NSAID) widely used for the management of osteoarthritis, rheumatoid arthritis, ankylosing sponydlitis, and acute gouty arthritis. Reports of sulindac toxicity in the literature are rare. We report the case of a 22-year old male with a history of bipolar disorder who was brought to the emergency department after ingesting approximately 15 g of sulindac in a suicide attempt. He was found to have acute kidney injury and hyperbilirubinemia. Despite aggressive fluid resuscitation, his renal function progressively worsened requiring the initiation of hemodialysis. Ten days following ingestion of sulindac, he began to develop ischemic skin changes with a gangrenous appearance in his hands and feet. He continued to receive supportive treatment, and his acute kidney injury, hyperbillirubinemia, and ischemic skin necrosis eventually resolved. Clinicians should be aware of this long-acting NSAID and its ability to cause prolonged multisystem organ dysfunction.
authors.affiliation: Department of Internal Medicine, The Ohio State University, 395 W. 12th Avenue, Third Floor, Columbus, OH 43210, USA. john.vaughn@osumc.edu.
authors.forename: John L
authors.initials: JL
authors.lastname: Vaughn
authors.forename: Kejal V
authors.initials: KV
authors.lastname: Shah
authors.forename: Maroun M
authors.initials: MM
authors.lastname: Ghossein
authors.forename: William L
authors.initials: WL
authors.lastname: Meyer
authors.forename: Robert B
authors.initials: RB
authors.lastname: Kirkpatrick
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning*; D001714:Bipolar Disorder / Q000150:complications; D062787:Drug Overdose; D005440:Fluid Therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced*; D007511:Ischemia; D008297:Male; D009336:Necrosis; D006435:Renal Dialysis; D012151:Resuscitation; D012867:Skin / Q000098:blood supply; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology; D013406:Suicide, Attempted; D013467:Sulindac / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013467:Sulindac