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cetirizine overdose symptoms

You might only need to use one dose of Zyrtec. but these symptoms are most likely due to excessive intake of pseudoephedrine, Drug Safety;" Safety of Antihistamines in Children; Ten Eick; February 2001. sneezing runny nose itchy or watery eyes itchy throat or nose These reactions can happen after you touch or inhale allergens such as plant pollen, mold, or pet dander. tell your doctor and pharmacist if you are allergic to cetirizine, levocetirizine, hydroxyzine (Vistaril), or any other medications, or any of the ingredients in cetirizine injection. Second generation antihistamines do not usually have these effects. [3] Cetirizine is safe to treat perennial allergic rhinitis and urticaria in adults and children over the age of 6 months; it is indicated for treating seasonal allergies in adults and children two years and older. Use these dosage charts for infants and children under 12 years old: prednisone, fluticasone nasal, loratadine, montelukast, cetirizine, Benadryl, promethazine, diphenhydramine, Xolair. oral. Hair dye brand names can be deceiving, since, Sulfa allergies are different from sulfite allergies. As well as sedation, overdose often presents with anticholinergic symptoms (see Anticholinergic Syndrome). Learn more about the differences between sulfa allergies and sulfite allergies and how to treat, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. It's used to treat allergy symptoms, such as: Runny nose; Sneezing; . DOI: Use caution when giving cough and cold products to kids. Using Zyrtec with other drugs that make you drowsy can worsen this effect. Zyrtec (Cetirizine Orally Disintegrating Tablets), Zyrtec Dosage Charts (Infants & Children). Significantly decreased conscious stage or conscious state not improving as expected. A 12 Lead ECG preformed and assessed for Long QT and arrhythmias. // Leaf Group Lifestyle. In case of overdose, call the poison control helpline at 1-800-222-1222. Antihistamine toxicity. . All rights reserved. Zyrtec is used in adults and children to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. (2016). A person may accidentally inhale or ingest cyanide. Cetirizine is the generic form of the brand name medicine Zyrtec. Symptoms treated effectively include sneezing, rhinorrhea, postnasal discharge, nasal pruritus, ocular pruritus, and tearing. Toxic doses of antihistamines may happen when a person takes 3 to 5 times the normal amount. oral, You must chew the before you swallow it. Borowy, C. S., & Mukherji, P. (2019). Is That Legal? Use: Treatment of allergic rhinitis and sneezing and itching. What is cetirizine (Zyrtec) used for? GoMedii is a healthcare technology platform focused at In-Patient care that helps through the entire treatment journey from hospital/doctor discovery, treatment planning to pre-treatment & in-treatment at hospitals until the post treatment care. Its also not suggested if you breastfeed your child. In rare cases, drowsiness can lead to sedation. Cetirizine does not increase blood pressure and blood pressure is not listed as a side effect in the product information. Orygen Youth Health:1800 888 320. Call your doctor for medical advice about side effects. This is not a complete list of side effects and others may occur. Cardiac monitoring may be necessary with large overdoses. No serious symptoms were reported aside from restlessness and irritability, followed by drowsiness. Bladder rupture can occur-dont forget the need for a urinary catheter. In most cases of Zyrtec overdose, the user may become irritable and restless before experiencing drowsiness. How does gasoline exposure affect a person's health? The Royal Childrens Hospital (RCH) acknowledges the traditional owners of the land on which the RCH is situated, the Wurundjeri people of the Kulin Nation, and we pay our respects to their Elders past and present. Consult Contact Victorian Poisons Information Centre 13 11 26 for advice. Vanderbilt University Medical Center is committed to principles of equal opportunity and affirmative action. However, as with any medication, they can cause serious adverse effects if someone takes too much. Staff. In clinical trials, this side effect appeared to be related to the dose of cetirizine, with higher dosages increasing the risk of feeling drowsy. I was told that I had an allergic reaction to penicillin when I was a child. MNT is the registered trade mark of Healthline Media. Unintentional cetirizine overdose causing anticholinergic syndrome Copyright 2023 by Vanderbilt University Medical Center. Pseudoephedrine is a decongestant additive that may be fatal when taken in large doses by children under the age of 12. Diagnosing an antihistamine overdose usually starts with a discussion about all medications the person is taking and not just the antihistamines. Cetirizine is an allergy medication which you can buy at any pharmacy very easily. (People Also Like To Read: 5 Essential Health Check After Age of 35). Privacy Policy. Each persons tolerance to medication can vary. orally disintegrating tabletorally disintegrating tablet, Measure with the supplied measuring device (not a kitchen spoon). Restlessness, Nervousness and Irritability. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings change or loss of taste feeling hot headache heartburn increased sweating indigestion stomach discomfort, upset, or pain remember that alcohol can add to the drowsiness caused by this medication. When taken beyond the recommended amount, it can cause irregular heart rhythm and palpitations. Whether you have seasonal allergies, indoor allergies, pet allergies, food allergies, or a chemical sensitivity, an allergic response can trigger multiple symptoms, such as: Allergy medication is considered safe when used correctly and can provide quick relief from symptoms, but its possible to take too much. Cetirizine And Pseudoephedrine (Oral Route) - Mayo Clinic Everyday Health is among the federally registered trademarks of Everyday Health, Inc. and may not be used by third parties without explicit permission. Your healthcare provider recommends treatment based on your symptoms. Cetirizine (Zyrtec): Uses, Side Effects, Dosage & Reviews - GoodRx Zyrtec is available in generic form and over-the-counter ( OTC ). What is Zyrtec? Cetirizine: Uses, dosage, side effects, and more - Medical News Today 1996-2023 Everyday Health, Inc., a Ziff Davis company. Excessive tiredness Dry mouth Stomach pain Diarrhea Vomiting Consult a doctor about any unexpected side effects which you feel after taking cetirizine. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. There have been no deaths reported from Zyrtec overdose in humans and such studies have only been completed in mice and rats. dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7da3506f-2799-434c-e053-2a91aa0adabb, rch.org.au/clinicalguide/guideline_index/Antihistamine_poisoning/, accessmedicine.mhmedical.com/content.aspx?sectionid=42069832&bookid=391, poison.org/articles/2012-jun/antihistamines-using-them-safely, fda.gov/drugs/resourcesforyou/specialfeatures/ucm263948.htm, Zara Risoldi Cochrane, Pharm.D., M.S., FASCP, How to Use an EpiPen: Step-by-Step Instructions. Antihistamines can also relieve allergy symptoms in children, but they arent right for all children. Zyrtec is used in adults and children to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. Second-generation antihistamines are commonly used medications, including: Signs and symptoms of antihistamine overdose in children may include: After these symptoms appear, a child may experience: Symptoms of antihistamine overdose in adults may include: Second generation antihistamines tend to be less serious with an overdose.However, any overdose can be dangerous, and people should seek help from a medical professional or poison control immediately. Side effects of albuterol include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Copyright 1996-2023 Cerner Multum, Inc. Be sure that you understand these directions, and ask your healthcare provider if you have any questions. Avoid drinking alcoholic beverages while taking this medication. Here, learn about the symptoms and what to do. Generally, cetirizine is a safe and effective drug, but you should be aware of certain warnings and precautions when taking this drug. UseZyrtec (Cetirizine (Oral/Injection))exactly as directed on the label, or as prescribed by your doctor. Cetirizine: Uses, Side Effects, and Precautions - Healthline H1 blocker antagonizes (counteracts) the effects of histamine on H1 receptor sites. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. It relieves symptoms like sneezing, runny nose, itchy and watery eyes, and itchy nose or throat. Cetirizine is a prescription approved by the U.S. Food and Drug Administration (FDA), and over-the-counter antihistamine medication. An antihistamine overdose, also called antihistamine poisoning, occurs when theres too much of the medication in your body. Store at room temperature away from moisture, heat, and light. Cetirizine Side Effects: Common, Severe, Long Term - Drugs.com Antihistamines are a drug, and there is a. Overdose symptoms may include severe drowsiness, vision . I have it on my medical HelloPharmacist (You Might Also Like To Read: Amoxicillin Side Effects, Usage & Dosage Guide) Accidental ingestion:Parent information sheetfrom Victorian Poisons Information centre on the prevention of poisoning: Intentional selfharm: Referral to local mental health services e.g. Staff. Some experts say first generation antihistamines are more likely to result in death from accidents or overdoses than their second generation counterparts. Can lifestyle changes relieve hay fever? Consider repeat ECG at 6 hours if symptomatic. The medication comes in capsules, tablets, and a syrup. A typical dose for adults and children age 6 or older is one 10 milligram (mg) tablet, once daily. A Danish survey of antihistamine use and poisoning patterns. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. Avoid medication errors by using exactly as directed on the label, or as prescribed by your doctor. Data sources include IBM Watson Micromedex (updated 3 July 2023), Cerner Multum (updated 10 July 2023), ASHP (updated 10 July 2023) and others. More-serious though less common side effects include a rapid heart rate (tachycardia) or feelings of fluttering or a pounding heart (palpitations). My Pharmacy Won't Tell Me The Drug Expiration Date. Unintentional cetirizine overdose causing anticholinergic syndrome The incidence of anticholinergic syndrome due to second generation antihistamines is infrequently reported. Is it possible to overdose on Zyrtec? They may also use ipecac syrup, which causes the person to vomit. Antihistamines may be first generation (sedating) or second generation (nonsedating). Cetirizine - Uses | Dosage | Side Effects | Drug Warnings - iCliniq First generation antihistamines are more likely to cross the blood-brain barrier. Can You Take A Z-Pak If You Have A Penicillin Allergy? [1] [2] Cetirizine also effectively reduces hives' severity and pruritus in patients with idiopathic urticaria. Some antihistamines also work as sleep aids, cold and flu medicine, and motion sickness treatment. Sept 14, 2020: How Should Massive Ingestions of Acetaminophen be Treated? As well as their H1 effect, sedating antihistamines can have alpha adrenergic, anticholinergic and serotonergic effects. Benadryl is the brand-name version of an antihistamine called diphenhydramine. What does carbon monoxide poisoning feel like, and how to treat it. Inserting intravenous line (IV) may also be necessary to correct fluid imbalances. The Poison Center recommends evaluation in a health care facility if amount ingested of diphenhydramine (one of the most frequently ingested) is 7.5mg/kg or greater than 150 mg. -Relief of symptoms associated with perennial allergic rhinitis due to allergens (e.g., sneezing, rhinorrhea, postnasal discharge, nasal pruritus, ocular pruritus, tearing) (2016). Cetirizine is available in both oral and injection forms. Activated charcoal - activated charcoal suspension. GoMedii is a facilitation engine which comes 1st in the patient treatment value chain and collaborates with all stakeholders of the ecosystem. Taking cetirizine is generally not recommended during pregnancy. In one case study of an adult overdose, 150mg was taken (15 tablets) and only minimal effects were reported. Take cetirizine exactly as directed. Pheniramine Promethazine Trimeprazine Brompheniramine Lesser sedating antihistamines These medicines cause mostly peripheral H1 blockade with limited penetration into the CNS. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 2023 Healthline Media UK Ltd, Brighton, UK. No matter how much a person overdoses, they should seek medical help or call a poison control center. This medication is also used as a treatment to provide relief of cold symptoms and other conditions . Which Are The Top 8 Hospitals In Kolkata? Heres what you need to know. If you take these types of antihistamines, its important that you dont take a separate decongestant. Fortunately, Zyrtec, also known as cetirizine, belongs to a newer class of antihistamines that produce far less dramatic signs of overdose. Overdose Signs of Zyrtec | Healthfully These two types may lead to different reactions if a person takes too much. Seizures or severe agitation should be treated with benzodiazepines see. However, they should always call the AAPCC or a doctor to be sure this is safe. Research has found them less likely to cause dangerous effects if a person takes too much. Your healthcare provider may also insert a tube into the stomach to irrigate or pump out the drug (gastric lavage). Toxicity occurs after 3-5 times the usual daily dose. Zyrtec (Cetirizine): Uses, Dosage, Side Effects, Interactions - RxList Zyrtec (Cetirizine)is a non-prescription antihistamine used to treat allergies and hives. Allow the to dissolve in your mouth without chewing. If someone is not sure about the amount of antihistamine they took, a doctor may need to conduct a physical exam. Also, it clears if you are allergic to any antihistamine do not take cetirizine. Who can and can't take Zyrtec Pregnancy and breastfeeding Zyrtec (cetirizine) and breastfeeding What is zyrtec used for Zyrtec dosage Before taking Zyrtec Cautions with other medicines How and when to take Zyrtec Zyrtec dosing information Zyrtec Adult Dosage What if I forget to take Zyrtec? Any child whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered. Usual Geriatric Dose for Allergic Rhinitis: 5 to 10 mg orally once a day -Intranasal antihistamines may be used concomitantly for patients with episodic, perennial, and/or seasonal allergic rhinitis. Youll likely receive activated charcoal in the hospital. This drug may be used as a treatment for annual or seasonal allergic and vasomotor rhinitis (inflammation of the membranes of the nose not caused by an allergy). 1.9% of children aged 6 to 11 years experienced drowsiness with 5mg of cetirizine and 4.2% of children experienced drowsiness with 10mg of cetirizine. This product is used in emergency situations to help reverse the effects of poisoning. Second generation antihistamines are newer drugs and are less likely to have these effects. This calculation is based on the half-life of cetirizine, which is 8.3 hours, and experts say it takes 4 to 5 half-lives for a drug to fully leave your body which works out to 33 to 40 hours. Antihistamine Overdose: Types, Symptoms, and Treatment - Healthline Non-sedating antihistamine overdoses tend to be less toxic and less severe. Minor, accidental overdoses can usually be managed at home, under the guidance of a healthcare provider or the poison control center. These include mild nausea, dizziness, vomiting, diarrhea, and stomach pain. Antihistamine overdose treatment focuses on stabilizing your health and providing supportive care. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Please email me with any suggestion at. Also, discuss any ongoing or bothersome side effects. headache, dizziness, feeling light-headed. Its used to treat allergy symptoms, such as: Zyrtec is in a class of drugs called antihistamines. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. -Maximum dose: 5 mg/day Is the ketogenic diet right for autoimmune conditions? Treat any effects with symptomatic management. Zyrtec (Cetirizine) (Oral, Injection) - Side Effects, Interactions This guideline will only deal with H1 antagonists. Zyrtec is also used to treat itching and swelling caused by chronic urticaria (hives). Cetirizine is classed as a non-drowsy (non-sedating) antihistamine, but it does make some people drowsy. For intentional poisoning, a risk assessment should indicate that the child or young person is at low risk of further self harm in the discharge setting. If features of poisoning have not developed at 6 hours post-ingestion In overdose symptoms can include dizziness, tachycardia, headache drowsiness or agitation. Adverse events reported after an intake of at least 5 times the recommended daily dose are: confusion, diarrhoea, dizziness, fatigue, headache, malaise, mydriasis, pruritus, restlessness . signs of an allergic reaction. Or, if you have chronic or seasonal allergies, you may need to take it regularly to prevent symptoms during the time your allergies are active. It works by blocking the action of a substance in your body called histamine. How it works Cetirizine may be used to treat the symptoms of an allergic reaction or insect bite. There are two primary mechanisms of action that cause toxicity in antihistamines overdose. It is contraindicated to patients who are unconscious or who have decreased level of consciousness. Overdose symptoms may include severe drowsiness, vision problems, agitation, fast heartbeats, stomach pain, nausea, vomiting, trouble walking, trouble swallowing or speaking. American Society of Health-System Pharmacists, Inc. Disclaimer, U.S. Department of Health and Human Services. If the condition gets bad after taking this medicine then consult a doctor as earlier as you can before it gets worse. Cetirizine and pseudoephedrine is a combination of an antihistamine and a decongestant used to treat the symptoms of seasonal or yearly allergies. In some cases, doctors may give a person activated charcoal, which helps prevent the absorption of some medications and chemicals in the gut. Avoid driving or hazardous activity until you know how this medicine will affect you. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. What special precautions should I follow? Avoid medication errors by using exactly as directed on the label, or as prescribed by your doctor. Be sure to read medicine labels carefully and dont take more than directed. Depending on the severity of the overdose, the healthcare provider may prescribe certain medications. Comment: USES: Cetirizine is an antihistamine used to relieve allergy symptoms such as watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching. First generation antihistamines available over-the-counter include: These medications can act as sedatives, so they can make a person feel tired or dizzy. People can overdose on any type of antihistamine. Levocetirizine is an antihistamine that may be used to reduce allergy symptoms such as red, itchy, or watery eyes; a runny nose; sneezing; rashes; or reactions to insect bites or stings. Do not drive a car or operate machinery until you know how this medication affects you. The AAPCC helpline is open 24 hours and is toll-free. Deep sedation has been noted in an adult after ingesting more than 150mg (15 times the recommended daily dose). All rights reserved. You must chew the chewable tablet before you swallow it. You should not use Zyrtec if you are allergic to cetirizine or similar medicines such as: levocetirizine or hydroxyzine. We avoid using tertiary references. (You Might Also Like To Read: Amoxicillin Side Effects, Usage & Dosage Guide). -Treatment of uncomplicated skin manifestations of chronic idiopathic urticaria Information is also available online at https://www.poisonhelp.org/help. Generic name: cetirizine [se-TIR-a-zeen] Even so, check with a doctor if you have side effects. 2023 Healthline Media LLC. Jensen LL, et al. Contact Us All rights reserved. You can learn more about how we ensure our content is accurate and current by reading our. Cetirizine comes as a solution (liquid) to be given intravenously (into the vein). How Many Doses of Benadryl Can a Child Have if Having an Allergic Reaction to Something? Presented as syrup, immediate or modified- release tablets. Here are some tips to avoid ingesting too much: Make sure you read labels carefully. Your symptoms may start off mild and then gradually worsen over time. Nevertheless, taking more than directed does certainly increase the risk of them occurring. On my prescription, it says to take two tablets once weekly. -Initial dose: 2.5 mg orally once a day Some antihistamines can interact with other drugs you take. It blocks histamine, a natural chemical in your body that can cause allergy symptoms like itchiness, itchy eyes, or runny nose. In rare cases, drowsiness can lead to sedation. Cetirizine is taken by mouth with or without food. The prescribing information gives the following data regarding lethal doses in rodents: Based on the available information, and animal studies, it would take doses far exceeding the recommended daily dosage to experience serious side effects. The prognosis depends on the amount of antihistamine ingested and the extent of an overdose, but a full recovery is possible with immediate medical treatment. Antihistamine toxicity. These effects are usually not emergencies. Zyrtec is an antihistamine that reduces the effects of natural chemical histamine in the body. These include accidental overdoses and intentional misuse. Bamboo - Atropine, Hyoscyamine, Scopolamine, Phenobarbital, Devil's Club - Casanthranol, Docusate Potassium, Mullein - Potassium Phosphate (prescription Drug), Glucomannan - Iodinated Benzoic Acid Derivatives, Detoxification Footpads - Doxazosin Mesylate, Question About How To Take Multiple Herbal Supplements At Once. Deep sedation has been noted in an adult after ingesting more than 150mg (15 times the recommended daily dose). Nonetheless, people can overdose on both types. This author has been verfied for credibility and expertise. As with any medication, taking too much can be harmful. In our latest question and answer, the pharmacist discusses whether or not it is possible to overdose on Zyrtec (cetirizine). If you or your loved one has ingested more than three times the normal therapeutic daily dose, dont hesitate to call paramedics. Decontamination - Consider activated charcoal after massive ingestion in older/sedating anti histamines, and within 1 hour / or after airway protection. 1st generation antihistamines tend to be sedating and include: Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton), and Brompheniramine (Dimetapp). Can you overdose on Prozac, and what to do? Overdose symptoms may include nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, . FDA Approves First Over-the-Counter Birth Control Pill, Read Zyrtec (Cetirizine (Oral/Injection)) Reviews. Some people, especially the elderly or children, may also find their thinking, judgement, and coordination impaired. Zyrtec Oral: Uses, Side Effects, Interactions, Pictures - WebMD In mild cases, an individual may be able to use self-care at home. Antihistamines are typically safe when a person takes the correct amount. Why Parkinson's research is zooming in on the gut. ds. Zyrtec Overdose (Cetirizine) - Drugsdb.com How should this medicine be used? Antihistamines also inhibit the binding of acetylcholine to muscarinic receptors (therefore called antimuscurinic) which causes anticholinergic signs and symptoms. Monitor EKG for widening QRS and consider alkalinizing the serum with sodium bicarbonate if heart rate is 120 bpm and QRS duration greater than 120 milliseconds. Medical Visa From Democratic Republic Of Congo (DRC) To India, Laser Angioplasty Treatment Cost and Hospitals in India, Get Cushing Syndrome Treatment in India With GoMedii. Cetirizine is used when needed. Admission should be considered for all children or young people with an intentional poisoning. Ankylosing Spondylitis Pain: Fact or Fiction, https://www.fda.gov/consumers/consumer-updates/allergy-relief-your-child, https://www.ncbi.nlm.nih.gov/books/NBK482318/, https://www.tandfonline.com/doi/full/10.3109/15563650.2015.1006400, https://adc.bmj.com/content/101/10/968.full, https://aacijournal.biomedcentral.com/articles/10.1186/s13223-019-0375-9, https://accessmedicine.mhmedical.com/book.aspx?bookid=391, https://www.tandfonline.com/doi/abs/10.1080/15563650.2019.1634812?journalCode=ictx20, Minor hallucinations may be an early sign of Parkinson's-related cognitive decline, 6 key food groups that may help lower cardiovascular risk, Deep-sleep brain waves are linked to blood sugar control, Gut bacteria can increase plaque buildup in heart arteries. It was noted that the patient was 'somnolent' (i.e. Ive seen it missed because the top of the bladder was at the umbilicus. EpiPens can help prevent anaphylaxis from becoming life threatening. -Maximum dose: 5 mg/day Clinical Practice Guidelines : Antihistamine poisoning It works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction.Cetirizine does not prevent hives or prevent/treat a serious allergic reaction (such . We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Be cautious, and dont drive your car or use machinery until you know for sure how your body will respond to cetirizine. -Maximum dose: 10 mg/day. Dry as a bone, red as a beet, hot as a hare, mad as a hatter, and blind as a bat is an old saying that emergency room doctors used to describe patients who had taken excessive quantities of antihistamines. What Does 'Take Two Tablets By Mouth Once Weekly' Mean? Call your doctor if your symptoms do not improve, or if they get worse. [18] Like all drugs, it is possible to overdose on Zyrtec (cetirizine), Taking over the recommended amount can increase the risk and severity of side effects such as dizziness, drowsiness, blurred vision, and constipation, It would take dosages far exceeding the maximum recommended amount to experience serious side effects, such as cardiovascular complications. https://www.tandfonline.com/doi/abs/10.1080/15563650.2019.1634812?journalCode=ictx20, Certified Poison Specialist, Tennessee Poison Center, I am interested in any questions you would like answered in the Question of the Week. Ask a doctor or pharmacist before using cetirizine if you have any health problems. (2018). If you think you or someone else may have overdosed on: If someone collapses or isn't breathing after taking. Antihistamines work by preventing the effects of a substance called histamine, which is produced by the body. extreme sleepiness or unusual drowsiness fast, slow, pounding, or irregular heartbeat or pulse feeling anxious giddiness headache irritability muscle weakness or tenderness nausea restlessness shallow, irregular, fast, or slow breathing sleeplessness or trouble in sleeping abdominal and/or chest pain thirst

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