Figure 619

Certain personality features and clinical findings characterize patients prone to analgesic abuse. These patients tend to deny analgesic use on direct questioning; however, their history can be revealing. In all cases, a relationship exists between renal function and the duration, intensity, and quantity of analgesic consumed. The magnitude of injury is related to the quantity of analgesic ingested chronically over years. In persons with significant renal impairment, the average dose ingested has been estimated at about 10 kg over a mean period of 13 years. The minimum amount of drug consumption that results in significant renal damage is unknown. It has been estimated that a cumulative dose of 3 kg of the index compound, or a daily ingestion of 1 g/d over 3 years or more, is a minimum that can result in detectable renal impairment.

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