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Patients with botulism may present with symptoms of ptosis, diplopia, swallowing and speech disorders, cranial nerve findings, generalized weakness or paresis of the respiratory muscles.
Overdose of botulinum toxin is a relative term and depends upon dose, site of injection and underlying tissue properties. Local weakness is usually well tolerated and resolves spontaneously without intervention. However, dysphagia may result in loss of airway protection and aspiration pneumonia. Patients or caregivers should be advised to seek immediate medical consultation if swallowing, speech or respiratory disorders arise.
There have not been any reported instances of systemic toxicity resulting from accidental injection or oral ingestion of botulinum toxin product. Should overdosage occur, the patients should be medically supervised for several days for signs or symptoms of systemic weakness or muscle paralysis.
The entire contents of a vial is below the estimated dose (from primate studies) for toxicity in humans weighing ≥6 kg.
