Life-threatening hyperkalemia after 2 days of ibuprofen

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for pain treatment in older adults because they aremore effective than acetaminophen and lack the central nervous system side effects of opioids. Although the risks of long-term NSAID use are well known, short-term use of ibuprofen is generally considered to be safe. To our knowledge, this is the first report of acute kidney injury after only 2 days of ibuprofen use. A 73-year-old woman with diabetes and baseline creatinine of 0.94 mg/dL presented to the emergency department with weakness, nausea, and decreased urination after taking ibuprofen for 2 days for her fractured humerus. The patient was found to have a potassium of 8.6 mmol/L and a creatinine of 6.99 mg/dL. The patient was treated with intravenous calcium gluconate and sodium bicarbonate and admitted to the intensive care unit for emergent dialysis. The patient was discharged without long-term sequelae. This case demonstrates the danger of even short courses of NSAIDs in older adults with disease or medications, which predispose them to NSAID-induced acute kidney injury.