NSAID's, APAP, and Kids

John, a 12 year-old boy, developed fever and a cough. He has a history of asthma, so his parents began his usual MDI albuterol. His temperatures ranged from 101-103 F. By the second day, his appetite was decreased for solids but he succeeded in drinking sips of liquids. Mother followed the office nurses instructions and offered him either APAP or Ib every 4 hours, as he persisted in having fever of 100.5 - 101.5 F. Vomiting, not associated with cough, was noted on the third day and he was evaluated by his PCP. He was admitted to GHS Children's Hospital.

Admission Lab Values:

CBC WBC 12.9 Plt 235 Hgb 14.1

Na 139 K 5.3 CO2 21 Cl 104 BUN 45 Cr 2.1 Ca 9.9 Phos 4.7

UA 1.020 pH 6 ++ Alb + Bld 0-3 WBC 10-20 RBC

Mary, a 14 year-old girl, developed loose non-bloody stools, 2-3 times daily, with mild nausea and infrequent vomiting, 1-2 times daily. She did not feel like eating but was able to keep down sips of soda and juices. She complained of abdominal cramps and her mother, following her PCP's offiice nurse instructions, offered her Ib every 6 hrs. By the third day, malaise was prominent, and she visited the PCP. She was admitted to Children's Hospital.

Admission Lab Values:

CBC WBC 14.4 Plt 335 Hgb 13.1

Na 137 K 5.5 CO2 20 Cl 103 BUN 66 Cr 2.6

UA 1.016 pH 6 + Alb + Bld 3-5 WBC 5-10 RBC

Mark, a 5 year-old boy, had a history of having microscopic hematuria. Lab evaluation provided by the PCP indicated appaently normal renal functions and no apparent collagen-vascular disease. He developed a febrile URI and his parents, upon advice of the office nurse, offered Ib over several days. He appeared clinically ill and was admitted in complete acute renal failure, ascribed to the use of the NSAID. He failed to recover and required dialysis. His parents, after consultation with their legal counsel, filed suit for medical negligence and were offered a large out-of-court settlement after the Chief of Nephrology at the local Medical University reviewed the case findings.

Marie, a 16 year-old girl, developed a febrile URI. She was advised by her PCP office nurse to take APAP alternating with Ib every 2-4 hrs. She developed significang abdominal pain and presented to GHS Children's ER, from where she was admitted.

Admission Lab Values:

CBC WBC 16.2 Plt 355 Hgb 13.2

Na 133 K 5.2 CO2 18 Cl 101 BUN 58 Cr 2.3

UA amorphous debris 1.015 pH 6.5 +Alb +Bld 5-10 WBC 5-7 RBC

Renal Ultrasound: mildly echogenic kidneys with central medullary lucency