Risk factors:
(1) pre-existing peptic ulcer disease or gastritis
(2) large overdose of the NSAID
(3) decreased gut motility
The NSAIDs may mask:
(1) abdominal pain or tenderness associated with peritonitis
(2) fever associated with peritonitis
Findings that may suggest perforation:
(1) tachycardia
(2) tachypnea
(3) leukocytosis
(4) free air on abdominal X-ray
Conditions that may cause the physician to overlook the risk of ulceration:
(1) upper gastrointestinal bleeding
(2) presence of a mixed overdose, with the other drugs causing acute symptoms
A patient who has taken an overdose of NSAIDs should be observed until any abdominal pain resolves. Any pain should be viewed with concern, especially if it is increasing in intensity.
