ACUTE RENAL-INSUFFICIENCY IN IBUPROFEN OVERDOSE

Since the introduction of ibuprofen as a nonprescription drug in the U S, there have been reports of significant toxicity associated with lar ge ingestions (>400 mg/kg) in both children and adults. Acute renal in sufficiency is a rare, reversible effect of ibuprofen overdose documen ted in adults, but we could find no published pediatric cases. We repo rt a case of a healthy two-year-old boy, without a previous history of renal problems, who developed reversible acute renal insufficiency af ter a toxic ingestion of approximately 640 mg/kg ibuprofen. By II hour s, his initially normal creatinine began to rise, reaching a peak valu e of 181 mmol/L (2.1 mg/dl) by 27 hours. His urinalysis showed moderat e microscopic hematuria without the presence of casts or proteinuria. No problems arose with fluid management. Normalization of his renal fu nction occurred by 72 hours. A serum ibuprofen concentration obtained by high-performance liquid chromatography and drawn approximately four hours after ingestion was 1724 mu mol (therapeutic serum concentratio n, 50-250 mu mol). This case demonstrates that acute, reversible renal insufficiency can occur in healthy children after a severe overdose o f ibuprofen; hence, renal function should be monitored in such instanc es.