An 8-year-old boy has had a temperature of 38.8oC along with an upper respiratory tract infection over the past two days. His mother gives him medication to bring down his fever. Two days later, the boy becomes increasingly confused and lethargic, and starts vomiting heavily. Physical exam reveals a slightly enlarged and firm liver. His eyes are anicteric. Which of the following medications is likely responsible for this boy’s condition?
1.Acetaminophen
2.Acetylsalicylic acid
3.Ibuprofen
4.Indomethacin
5.Naproxen
Correct answer
Acetylsalicylic acid
Explanation:
Acetylsalicylic acid (choice B) is a non-selective cyclooxygenase (COX) inhibitor, which has anti-inflammatory, anti-pyretic, anti- platelet, and analgesic effects. One notable adverse effect is Reye’s syndrome, which is a potentially fatal condition seen in children under 15 years who take acetylsalicylic acid after an upper respiratory infection. The condition manifests as rapidly progressive liver failure and encephalopathy. Acetaminophen (choice A) also inhibits the COX enzyme, but has no anti-inflammatory or anti-platelet effects. Ibuprofen (choice C), indomethacin (choice D), and naproxen (choice E) are other non-selective COX inhibitors.