Plasma Exchange in the Setting of Acute Ibuprofen Poisoning: A Case and Review of the Literature.

Background and Clinical Significance: Extracorporeal therapies such as hemodialysis, continuous renal replacement therapy (CRRT) or therapeutic plasma exchange (TPE) are mainstay treatments for acute toxins, venoms and poisonings. Ibuprofen is a common drug implicated in acute toxicity, with a major complication being acute kidney injury (AKI). As such, these patients often receive hemodialysis or CRRT, which do not remove substances with high protein binding (>80%) and low volumes of distribution (Vd) (<0.2 L/kg). The pharmacokinetics of ibuprofen have these characteristics. While hemodialysis or CRRT can clear the accumulated toxic metabolites, they do not remove the ibuprofen that causes renal injury. In contrast, TPE can remove protein-bound drugs such as ibuprofen. Case Presentation: We describe the case of a previously healthy young male who presented with AKI due to ibuprofen toxicity requiring concurrent continuous renal replacement therapy and plasma exchange. Conclusions: TPE in conjunction with hemodialysis or CRRT is an effective treatment modality for ibuprofen toxicity.