Renal failure, acute hyperglycemia

Nausea, vomiting, tinnitus, and hyperventilation are seen early in toxicity. As severity of toxicity increases, intractable vomiting, hyperthermia, hypotension, tachycardia, confusion, coma, seizures, pulmonary edema, acute renal failure, and death may occur. Hyperglycemia may be seen early, whereas hypoglycemia may occur later in toxicity. Acid-base disturbances such as respiratory alkalosis and/or metabolic acidosis may be noted. Signs and symptoms of salicylate toxicity may be noted as blood levels rise over 30mgdN. ... 

Hypertension and tachycardia are the primary toxic manifestations of pseudoephedrine overdose. An amount of more than three or four times the maximum daily dosage for adults or children may produce symptoms of jS-adrenergic stimulation. In severe poisonings, cardiac dysrhythmias and cerebral hemorrhage due to hypertensive crisis may occur. Anxiety, muscle tremor, and seizures may result from CNS stimulation. Hallucinations, drowsiness, and/or irritability are more common symptoms exhibited by children. Hypokalemia and hyperglycemia may be noted. Acute renal failure and rhabdomyolysis have occurred in rare instances with large overdoses. 

Major differences exist between the metabolic, fluid, and electrolyte management of patients with acute versus chronic kidney disease (CKD). For example, positive nitrogen balance is more difficult to achieve in patients with acute renal failure (ARF) due to the increased rate of protein catabolism. Additionally, patients with acute renal failure are more likely to develop hyperglycemia during nutritional support and frequently are dialyzed by modalities that are not used commonly for the patient with end-stage kidney disease (ESKD). Because of these differences, the nutritional management of patients with ARF is discussed separately. 

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