Multisystemic effects

Lead (tap water, leaded paint chips, herbal remedies, gas-sniffing, glazed kitchenware, etc.) Acute N and V, GI distress and pain, malaise, tremor, tinnitus, paresthesias, encephalopathy (red or black feces) Chronic multisystem effects—anemia (X heme synthesis), neuronathv (wrist dronL nephropathy (proteinuria, failure), hepatitis, mental retardation (from pica), >1 fertility and 1 stillbirths Decontamination—gastric lavage + dimercaprol (severe) or EDTA or succimer (penicillamine if unable to use dimercaprol or succimer) Children succimer PO... 

Gastrointestinal effects. After a delay of minutes to hours, diffuse capillary damage results in hemorrhagic gastroenteritis. Nausea, vomiting, abdominal pain and watery diarrhea are common. Although prominent Gl symptoms may subside within 24 to 48 hours, severe multisystemic effects may still ensue. 

B. Chronic intoxication is also associated with multisystemic effects, which may include fatigue and malaise, gastroenteritis, leukopenia and anemia (occasionally megaloblastic), sensory predominant peripheral neuropathy, hepatic transaminase elevation, nonciiihotic portal hypertension, and peripheral vascular insufficiency. Skin disorders and cancer may occur (see below), and a growing body of epidemiological evidence links chronic arsenic ingestion with an increased risk of hypertension, cardiovascular mortality, and diabetes mellitus. 

Lead exerts multisystemic toxic effects that are mediated by multiple modes of action, including inhibition of enzymatic function interference with the action of essential cations, particularly calcium, iron, and zinc generation of oxidative stress changes in gene expression alterations in cell signaling and disruption of the integrity of membranes in cells and organelles. 

Chronic inorganic arsenic poisoning also results in multisystemic signs and symptoms. Overt noncarcinogenic effects may be evident after chronic absorption of more than 500-1000 g/d. The time to appearance of symptoms will vary with dose and interindividual tolerances. Constitutional... 

In recent times arsenic and arsenicals have been considered obsolete in medicine, because of their limited therapeutic value, multisystem toxicity, and apparent carcinogenic properties (SED-8, 502) (SED-9, 368). However, arsenic compounds have been used to treat various types of leukemia (1-3), including acute pro-myelocytic leukemia, chronic myelogenous leukemia, and multiple myeloma (4). Arsenic trioxide is effective in acute promyelocytic leukemia, achieving a complete... 

A schizophrenic patient died after ingesting 461 coins, the first reported case of a death associated with zinc intoxication (21). The patient presented with clinical manifestations consistent with the local corrosive as well as systemic effects of zinc intoxication and died 40 days after admission with multisystem organ failure. Many British post-1981 pennies, which contain mostly... 

Sarcoidosis is a multisystem disorder associated with chronic granulomatous interstitial nephritis. Biochemical abnormalities include hypercalcemia, hypercalciuria, and elevated serum ACE activity. The condition may be effectively treated with steroids. 

Hypothyroidism can lead to a variety of end-organ effects and a wide range of disease severity, from entirely asymptomatic individuals to patients in coma with multisystem failure. In the adult, manifestations of hypothyroidism are varied and nonspecific. In the child, thyroid hormone deficiency may manifest as growth retardation. 

Rarely have complications from CS exposure included haemoptysis and haematemesis (Anderson et al., 1996). A case of multisystem hypersensitivity reaction characterized by delayed development of cutaneous rash, pneumonitis, hypoxaemia, hepatitis and hypereosinophilia, with rapid response to corticosteroids, was described in a man heavily exposed to CS solution spray. The authors ascribed this to a systemic allergic reaction patch testing confirmed sensitization to CS (Hill et al., 2000). The possible abuse and complications from illegal drugs should be considered where clinical suspicions exists (Hayman and Berkely, 1971). Physicians should be aware of the possible contribution from formulation constituents some may exacerbate effects known to be produced by RCAs (e.g. eye injury and skin irritation) and others may introduce additional toxicological factors (such as the development of carbon monoxide intoxication from the absorption and metabolism of dichloromethane as a formulation solvent). 

CMV disease may still develop or relapse when HAART is not effective or the CD4+ count remains low. As well, incomplete immune recovery may not fully protect against CMV retinitis. Furthermore, HAART medications may not be easily obtained, especially in some underdeveloped countries. For these reasons, CMV retinitis continues to be a prevalent and serious opportunistic infection in AIDS. It is important to be aware of the features and treatment options for this potentially multisystemic infection in AIDS and other immunocompromised individuals. The treatment of CMV retinal infection remains challenging, especially due to the multiple side effects of anti-CMV medications. 

III. Clinical presentation. The multisystem toxicity of lead presents a spectrum of clinical findings ranging from overt, life-threatening intoxication to subtle, subcllnical effects. 

Bolivian hemorrhagic fever A multisystem disease caused by an arenavirus with insidious onset and progressive effects. 

Observational studies In 741 patients with coronary bypass and/or valve operations transfusion of more than 5.5 units of blood products was associated with a higher incidence of re-operation, neurological, infectious, and cardiac complications, multisystem organ failure, and deaths [10 ]. However, these results were distorted by confounding by indication, because patients who receive more than 5.5 units of blood are more severely ill than those who receive fewer transfusions or none at all. Studies of the potential harmful effects of blood transfusions should be carefully corrected for disease severity, for example by propensity score matching analyses [ll ]. Among propensity-matched patients undergoing... 

Niacin deficiency leads to unwanted multisystemic problems that are often associated with dermatological changes. Pellagra is a condition in which niacin deficiency causes a symmetrical pigmented rash, thickened skin and superficial scaling which are found in sun-exposed body areas. The classic triad of niacin deficiency are the three D s—dermatitis, diarrhoea and dementia (Hegyi et al. 2004). Some of the effects on the central nervous system include depression, anxiety, restlessness and poor concentration. In addition, alcoholic individuals with poor nutrition can develop pellagroid encephalopathy (Cook et al. 1998). The role of niadn deficiency in cardiovascular disease and lipid metabolism remains to be fully explored. 

When these drugs were the only ones implicated, there were nine reports presented to the Food and Drug Administration on Fiorinal and 16 attributed to Fioricet. Serious adverse events associated with Fiorinal were one case of acute overdose and two cases of hepatic and renal failure related to prolonged (more than 10 years) use. Serious adverse effects associated with Fioricet use were one case each of pancreatitis and multisystem illness, three deaths due to overdose, three cases of coma (presumably secondary to overdose), and two cases of other encephalopathy due to overdose. Drug dependence was reported twice. In short, serious adverse events were almost always associated with acute overdose (e.g. ingestion of 30 pills) or prolonged (e.g. 10 years) overuse [8]. 

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