Serious toxicity in a young child due to ibuprofen

An 18-month-old male presented to the emergency department (ED) for evaluat ion of lethargy and apnea. Four hours before presentation, the patient was found with an empty bottle of ibuprofen, an ingestion of as much as 7.2 gra ms (600 mg/kg). The ED course was remarkable for a 30-second tonic-clonic s eizure. Laboratory analysis was notable for metabolic acidosis. Four-hour a nd 7.5-hour serum ibuprofen levels were 640 and 39 mu g/mL, respectively. F ollowing treatment, the patient improved and was extubated the next morning . While metabolic acidosis has been frequently described at doses exceeding 400 mg/kg, seizures occurring early in the course of ibuprofen toxicity ha ve been rarely noted.