What is ibuprofen?

Ibuprofen (brand names: Advil, Motrin, Midol, Nuprin) is a commonly used nonsteroidal anti-inflammatory drug (NSAID) and is used to treat fever, pain, and inflammation (swelling) in humans. Ibuprofen and other NSAIDs treat inflammation by blocking certain processes in the body.

What is ibuprofen poisoning?

Ibuprofen poisoning occurs when a dog ingests a toxic dose of ibuprofen, either through misuse or by accident. Although relatively safe in humans, ibuprofen and other NSAIDs can be extremely harmful to dogs. Ibuprofen poisoning is very common, and even small doses can cause adverse effects and poisoning.

What causes ibuprofen poisoning?

Unfortunately, in addition to blocking enzymes (chemicals in the body) that cause inflammation, ibuprofen also blocks enzymes that are used to control normal gastrointestinal and kidney function. When ibuprofen is ingested, it is absorbed quickly into the blood stream.

In dogs however, the drug is recycled over and over in the body via the liver instead of being removed from the body. This recycling allows for repeated exposure and is responsible for the poisoning effects.

"In dogs however, the drug is recycled over and over in the body via the liver instead of being removed from the body."

Several risk factors can affect how sever the negative side effects of ibuprofen and other NSAIDs will be. These include high doses of the drug, pre-existing kidney disease, gastrointestinal disease, liver disease, dehydration, low blood pressure, heart disease, stress, trauma, spinal injury, surgery or anesthesia, age, and interactions with other drugs. Puppies and older dogs are at the highest risk.

What are the clinical signs of ibuprofen poisoning?

Ibuprofen poisoning causes many different clinical signs because many different organ systems can be affected. The signs also depend on how much ibuprofen was eaten.

Most commonly in dogs, clinical signs related to irritation and ulceration of the gastrointestinal tract are observed including decreased appetite, vomiting (sometimes with blood), diarrhea, depression, abdominal pain, dark tarry stools, and bloody stools.

"Ibuprofen poisoning causes many different clinical signs because many different organ systems can be affected."

Other clinical signs can include stupor (near-unconciousness), incoordination, increased or decreased drinking and urination, icterus (yellow discoloration of the skin and mucous membranes), pale mucous membranes, seizures and coma.

How is ibuprofen poisoning diagnosed?

Bloodwork including a complete blood cell count and serum biochemistry to evaluate organ function, as well as a urinalysis should be performed for all suspected cases of ibuprofen poisoning. These basic laboratory tests will check for blood loss from bleeding ulcers, infection from a perforation in the gastrointestinal tract, liver failure, and/or kidney failure. Radiographs (X-rays) or ultrasound may be performed to screen for gastrointestinal perforation and peritonitis. Coagulation tests and fecal exams may also be performed.

Tests to confirm the diagnosis include blood tests and endoscopy. Blood tests will determine how much ibuprofen is in the system. Endoscopy involves using special instruments to examine the gastrointestinal system and look for ulcers caused by ibuprofen. These tests may not be available at all clinics.

How is ibuprofen poisoning treated?

Ibuprofen poisoning treatment will depend on how soon the dog presents to the clinic. In cases presenting within 1 to 2 hours of ingestion, gastrointestinal decontamination may be performed. This includes inducing vomiting and administering activated charcoal repeatedly.

"Ibuprofen poisoning treatment will depend on how soon the dog presents to the clinic."

Supportive care will be started depending on the clinical signs and blood work and urinalysis results. Intravenous fluids will help with kidney function. Anti-vomiting medications along with gastrointestinal protectants (e.g., sucralfate and misoprostol) will be used to help protect the gastrointestinal system.

In patients that are anemic (have lost a lot of blood), blood transfusions may be required. Dogs with intestinal perforations may require emergency surgery. Medications to manage seizures are used as needed.

Throughout therapy, laboratory tests should be repeated to monitor for changes. Urine output should be measured to monitor for kidney failure.

What care will my dog require after treatment?

Gastrointestinal protectants should be administered for a minimum of 1 to 2 weeks following ibuprofen poisoning. Supportive care should continue until laboratory tests are normal or stable. In the cases of a full recovery, regular activities can resume. Some cats may have long-term damage such as kidney disease, and these complications from ibuprofen poisoning will need life-long management.