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Toxicity: Large doses are usually well tolerated. However, parenteral administration of high doses has produced toxic symptoms with, for example, reduced renal function and a defect in the blood-brain barrier. Acute reactions are mainly due to hypersensitisation.
Symptoms: Toxic reactions; nausea, vomiting, diarrhoea, electrolyte disorders, decreased level of consciousness, muscle fasciculations, myoclonus, spasms, coma, haemolytic reactions, renal failure, acidosis.
In rare cases, an anaphylactic reaction can occur within 20-40 minutes.
Treatment: Treatment is likely needed only in patients with severely impaired renal function, since patients with normal kidneys excrete penicillins at a fast rate. No specific treatment can be recommended.
Symptomatic treatment: In difficult cases: hemoperfusion or haemodialysis.
In anaphylactic reaction: Adrenaline 0.1-0.5 mg slowly intravenously. Hydrocortisone 200 mg intravenously, possibly promethazine 25 mg intravenously. Fluid. Acidosis correction.
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