Hepatic and Renal Dysfunction

Hypersensitivity, probably as a manifestation of pseudo-allergy is not infrequent. Especially in patients with impaired renal function various skin eruptions can be followed by a potentially fatal syndrome with fever, hepatic and renal dysfunction and eosinophilia. 

Adverse effects include depression of bone marrow which gives rise to leukopenia, thrombocytopenia, reticulocytopenia. GI disturbances, oral and anal ulceration, hepatic and renal dysfunction and peripheral neurotoxicity with high doses. 

Most common adverse effects include nausea, vomiting, diarrhea, abdominal pain, bone marrow depression with agranulocytosis, thrombocytopenia, and aplastic anemia. Cumulative toxicity is possible in elderly patients, hence it should be used cautiously. Care also should be exercised in patients with cardiac, hepatic, and renal dysfunctions. Colchicine causes teratogenicity in animals, and there are evidences of the risk of fetal chromosomal damage in humans. Colchicine should not be administered by the parenteral route as it causes severe local irritation. 

There have been reports of hepatitis and renal dysfunction in patients taking sulfasalazine, therefore liver function tests and renal function tests should be performed at regular intervals. 

Guattery, J.M., Milne, J., House, R.K. Observations on hepatic and renal dysfunction in trichinosis. Anatomic changes in these organs occurring in cases of trichinosis. Amer. J. Med. 1956 21 567-582... 

A gasping syndrome in small premature infants who had been exposed to intravenous formulations containing benzyl alcohol 0.9% as a preservative has been described (SEDA-10, 421) (SEDA-11, 475) (6-8). The affected infants presented with a metabolic acidosis, seizures, neurological deterioration, hepatic and renal dysfunction, and cardiovascular collapse. Death was reported in 16 children who received a minimum of 99 mg/kg/day of benzyl alcohol. This metabolic acidosis is caused by accumulation of the metabolite benzoic acid and is mainly related to an excessive body burden relative to body weight, so that the load of the metabolite may exceed the capacity of the immature liver and kidney for detoxification. The FDA has recommended that neither intramuscular flushing solutions containing benzyl alcohol nor dilutions with this preservative should be used in newborn infants. 

Watson described 50 black children who had died following the administration of this toxin [16]. Post-mortem examination was conducted in all cases confirming the diagnosis of impila poisoning. No common trend was noted in the clinical presentation of these children. It was concluded that hypoglycemia and evidence of hepatic and renal dysfunction, were strong indicators of impila poisoning. 

The only occupational health observation in humans was of contact dermatitis in factory workers handling butter yellow. The target organs for toxicity are skin, liver, and bladder. Potential symptoms of overexposure are enlarged liver, hepatic and renal dysfunction, contact dermatitis, coughing, wheezing, difficulty in breathing, bloody sputum, bronchial secretions, frequent urination, hematuria, and dysuria. 

Given the CNS and respiratory depression properties of dibutyl ether, treatment is directed at maintaining respiration and treating irritation at the site of exposure. Patient should be monitored for respiratory distress and apnea, hyperglycemia, as well as hepatic and renal dysfunction. 

Toxicity Skin reactions (blushing, erythema, urticaria) may occur. With long-term use, neurotoxicity (eg, retinal degeneration), hepatic and renal dysfunction, and severe coagulopathies have been reported. Rapid intravenous administration may cause histamine release and hypotensive shock. 

The use of oxycodone has been reviewed, highlighting the importance of hepatic and renal dysfunction [131 ]. In severe hepatic impairment the clearance of oxycodone falls by 75% and the volume of distribution... 

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