Abstract: SA-PO986

An Unusual Cause of Delirium: Ibuprofen Induced Renal Tubular Acidosis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Abu hwij, Roulan, cleveland clinic- akron general, Akron, Ohio, United States
  • Jaradat, Dima, cleveland clinic- akron general, Akron, Ohio, United States
  • Bakhous, Aziz, cleveland clinic- akron general, Akron, Ohio, United States
Background


Ibuprofen is one of the easily accessible over the counter (OTC) medication, general population perceive it as nonharmful. Few cases in the literature reported ibuprofen as a cause of distal renal tubular acidosis (dRTA) associated life-threatening hypokalemia. It is hypothesized that carbonic anhydrase (CA) inhibition may play a role in the pathogenesis of ibuprofen-induced dRTA.

Methods

Our 65-year-old female patient presented to the ER with altered mental status, she has a history of fibromyalgia, chronic pain syndrome and hypertension. laboratory workup showed K of 2.2, HCO3 9, BUN 18, Cr 0.69, AG 12, Mg 2. Urine studies showed K of 13, Na 63, CL 71, urinary anion gap 5, urine PH 6.5 and her VBG revealed PH of 7.179. Serologic studies including ANA, C3, C4, RF, anti-ccp and urine protein electrophoresis were all unremarkable.
Patient was managed supportively with bicarbonate infusion and potassium replacement. We discontinued iboprofen. Her mental status improved gradually.
Our patient was diagnosed with RTA type 1. Ibuprofen is the presumed underlying culprit as she had more than 6 months of daily use of ibuprofen 800 mg bid. After ibuprofen was stopped and with supportive management her symptoms as well as her labs improved. No other etiologies were identified including auto-immune diseases (Rheumatoid arthritis, Sjogren's syndrome, Multiple myeloma). No family history of dRTA was identified.

Conclusion


This case highlights the association between ibuprofen use and dRTA. We hope to raise awareness among the general population and physicians regarding the need for more strict NSAID use “an OTC drug”.