Signs and Symptoms of Toxicity

Clinical Side Effect Yes/No Clinical Side Effect Yes/No 

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Nurses must carefully monitor the patient s blood levels of drugs to ensure that they remain within the therapeutic range Any deviation should be reported to the primary health care provider. Because some dragp can cause toxic reactions even in recommended doses, the nurse should be aware of the signs and symptoms of toxicity of commonly prescribed drugs. 

Clinical signs and symptoms of toxicity are related to the overstimulation of muscarinic, nicotinic, and central nervous system receptors in the nervous system. Muscarinic receptors are those activated by the alkaloid drug muscarine. These receptors are under the control of the parasympathetic nervous system, and their hyperactivity results in respiratory and gastrointestinal dysfunction, incontinence, salivation, bradycardia, miosis, and sweating. Nicotinic receptors are those activated by nicotine. Hyperactivity of these receptors results in muscle fasciculations even greater stimulation results in blockade and muscle paralysis (Lefkowitz et al. 1996 Tafliri and Roberts 1987). Hyperactivity of central nervous system receptors results in the frank neurological signs of confusion, ataxia, dizziness, incoordination, and slurred speech, which are manifestations of acute intoxication. Muscarine and nicotine are not... 

Toxicity Serum electrolytes (especially potassium), renal function tests, BP, ECG (hyperkalemia), signs and symptoms of toxicity... 

Lipid profile, LFTs, serum CPK, electrolytes, blood glucose, signs and symptoms of toxicity (GI symptoms, headache, rash) pattern of daily bowel activity and stool... 

Bone mass density (T-score, hip, spine), N-telopeptide serum calcium (adjusted forhypoalbuminemia), phosphorus, magnesium, renal function, liverfunction, serum electrolytes, signs and symptoms of toxicity (i.e., esophageal irritation)... 

Notify the physician if signs and symptoms of toxicity, including blurred vision, diarrhea, nausea, dizziness, flu-like symptoms, or headache... 

It soon became evident that no available antidotes could block the pharmacologic activity of these chemicals, alleviate the signs and symptoms of toxicity, or restore normal bodily functions after exposure. Atropine readily antagonized the muscarinic actions, including those in the central nervous system (CNS), but elicited no reversal of the nicotinic effects. Better forms of therapy were sought, particularly to alleviate the nicotinic effects of anticholinesterase agents. 

Description of the clinical signs and symptoms of toxicity shown by each group of animals after treatment. 

Effect. Reliable biomarkers of effect in DNOC exposure include headaches, hyperthermia, profuse sweating, increased pulse rate, and dyspnea are other common signs associated with DNOC exposure. In severe cases, tachycardia, delirium, coma, and convulsions are usually observed in humans. Blood levels >40 pg DNOC/g in workers have been correlated with signs and symptoms of toxicity and/or death (Bidstrup et al. 1952 Pollard and Filbee 1951 Steer 1951). Other authors have also suggested that blood levels approaching 40-48 pg DNOC/g may be indicators of DNOC toxicity (Harvey et al. 1951 King and Harvey 1953b). 

A chart review of psychiatric hospital admissions between 1990 and 1996 showed that 6.8% of 2210 patients who were given lithium had at least one serum concentration of 1.5 mmol/1 or over (43% of these were increased at admission) and of those only 28% had signs and symptoms of toxicity (363). 

The chronic toxicity of vitamin A is a more general cause for concern prolonged and regular intake of more than about 7,500 to 9,000 /rg per day by adults (and significandy less for children) causes signs and symptoms of toxicity affecting ... 

Signs and symptoms of toxicity are noted during and after exposure... 

Inhalation is the major route of exposure. Diphosgene is extremely damaging to mucous membranes, eyes, skin, and the respiratory tract, and may cause minor irritation to severe tissue damage and death. Toxicity effects vary with the concentration of vapor and the length of exposure. Signs and symptoms of toxicity may be immediate or delayed. The delayed (up to 6h) acute respiratory distress syndrome is characteristic of chocking agent inhalation. 

Signs and symptoms of toxicity in animals and livestock would be similar to those in humans. Livestock symptoms include diarrhea, bloody stools, anorexia, weakness, urge to urinate, and dysrhythmias. Treatment should consist of symptomatic and supportive care. 

Hint Make sure that the patient and the patient s family can describe the signs and symptoms of an allergic response to the medication and signs and symptoms of toxicity. 

Isoniazid inhibits phenytoin parahydroxylation, and signs and symptoms of toxicity occur in -25% of patients given both drugs, particularly in slow acetylators. Concentrations of phenytoin in plasma should be monitored, and its dose adjusted if necessary. 

Although strong evidence indicate.s that PONl levels and, in some cas es, the Q192R polymorphism determine the efficiency with which an individual will detoxify a specific OP, further proof in human populations is still needed. In particular, studies are needed in which PONl status is correlated with the degree of expo.sure and with signs and symptoms of toxicity. 

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