sulindac and Drug-Overdose

Sulindac is a long-acting nonsteroidal anti-inflammatory drug (NSAID) widely used for the management of osteoarthritis, rheumatoid arthritis, ankylosing sponydlitis, and acute gouty arthritis. Reports of sulindac toxicity in the literature are rare. We report the case of a 22-year old male with a history of bipolar disorder who was brought to the emergency department after ingesting approximately 15 g of sulindac in a suicide attempt. He was found to have acute kidney injury and hyperbilirubinemia. Despite aggressive fluid resuscitation, his renal function progressively worsened requiring the initiation of hemodialysis. Ten days following ingestion of sulindac, he began to develop ischemic skin changes with a gangrenous appearance in his hands and feet. He continued to receive supportive treatment, and his acute kidney injury, hyperbillirubinemia, and ischemic skin necrosis eventually resolved. Clinicians should be aware of this long-acting NSAID and its ability to cause prolonged multisystem organ dysfunction.

Topics: Acute Kidney Injury; Anti-Inflammatory Agents, Non-Steroidal; Bipolar Disorder; Drug Overdose; Fluid Therapy; Humans; Hyperbilirubinemia; Ischemia; Male; Necrosis; Renal Dialysis; Resuscitation; Skin; Skin Diseases; Suicide, Attempted; Sulindac; Young Adult

The results of an accidental overdose fatality in a child involving disopyramide and sulindac are reported in this paper. Quantitation of disopyramide was performed by gas chromatography using codeine as the internal standard. Sulindac was assayed by high- performance liquid chromatography using ketoprofen as the internal standard. The postmortem blood concentrations of disopyramide and sulindac were 41.3 and 12.2 mg/L, respectively. The concentrations of disopyramide and sulindac were also quantitated in the liver, in bile, and in urine.

Topics: Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Bile; Calibration; Child, Preschool; Chromatography, Gas; Chromatography, Thin Layer; Disopyramide; Drug Overdose; Humans; Liver; Sulindac; Tissue Distribution