Acute kidney injury and severe septicemia: toll of over-the-counter availability of drugs

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) act mainly on peripheral pain mechanisms and on the central nervous system to raise the pain threshold. Their usage is widespread and many of these drugs are available over-the-counter (OTC) and hence self-medicated and abused. Drugs and Cosmetics Act is quiescent on this issue. Literature review has shown that, nimesulide, a preferential COX-2 inhibitor group of NSAID is notorious to produce hepatic and renal damage besides gastric mucosal injury which surpass its benefits. Here a case has been reported on life-threatening condition faced on cumulative over-consumption of this OTC drug. A young female was admitted with sudden onset of abdominal pain, fever and vomiting. On examination, findings were almost within normal limit whether laboratory investigation over 2 successive days of admission revealed hyponatraemia, hypokalaemia, severe anaemia, deranged renal and liver function tests, nephrolithiasis in USG and sepsis without detection of any septic foci. The patient was managed conservatively with broad spectrum antibiotics besides supportive management. Nephrological and surgical consultation was taken alongwith. Upon being ambulatory and parameters on reaching to normal value, the patient was discharged following fortnight of hospitalization. Easy accessibility of OTC drugs even at online pharmacy is increasing the burden of iatrogenic ill-health to a great extent. If necessary steps are implemented for appropriate self-medication by Central Drugs Standard Control Organization (CDSCO) that might save Disability Adjusted Life Years (DALYs), health resources and thousands of lives.