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Over a 6-month period, two patients presented to a community hospital emergency department with perforated gastric ulcers as the result of recreational misuse of over-the-counter ibuprofen—codeine preparations.

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Non-steroidal anti-inflammatory drugs are widely available as over-the-counter preparations. Adverse effects of these drugs include nephrotoxicity.

Life-threatening hypokalaemia from abuse of nurofen plus

A woman aged 45 came to hospital in a drowsy state, with headache. Investigations revealed a serum potassium of 2.

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She recovered spontaneously, but at discharge 48 hours later her potassium concentration had fallen to 2. Six months before, serum potassium had been 4.

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She had two further admissions in the next six weeks with drowsiness and general weakness, on each occasion with profound hypokalaemia potassium 2. On the third admission, further investigation revealed an arterial pH of 7.

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She had a normal serum magnesium, 0. Urine pH was 7. Potassium rose to 4.

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A urine drug screen was positive for ibuprofen, paracetamol, opioids and benzodiazepines, and she was subsequently readmitted after self-poisoning with Nurofen Plus ibuprofen mg, codeine phosphate Acute renal failure and interstitial nephritis are well documented adverse effects of non-steroidal anti-inflammatory drugs. However, we have found only two reports of effects of these drugs on renal tubular acidification.

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In both, overdose of ibuprofen was reported as causing type 2 proximal renal tubular acidosis. Abuse of such agents can easily escape notice.

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National Center for Biotechnology InformationU. J R Soc Med. Author information Copyright and information Disclaimer. Correspondence to: Dr Paul Lambert E-mail: ku.

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This article has been cited by other articles in PMC. References 1. British National Formulary. Renal tubular acidosis with severe hypokalemic tetraparesis after ibuprofen intake. Support Center Support Center.

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