Category

Toxicity

Grade0

Grade1

Grade2

Grade3

Grade4

Haematology

WBC (x103/l)

4

3.0 - 3.9

2.0 - 2.9

1.0 - 1.9

< 1.0

Haematology

Platelets (x103/l)

WNL

75.0 - normal

50.0 - 74.9

25.0 - 49.9

< 25.0

Haematology

Haemoglobin (g/dl)

WNL

10.0 - normal

8.0 - 9.9

6.5 - 7.9

< 6.5

Haematology

Granulocytes/ Bands (x103/l)

2

1.5 - 1.9

1.0 - 1.4

0.5 - 0.9

< 0.5

Haematology

Lymphocytes (x103/l)

2

1.5 - 1.9

1.0 - 1.4

0.5 - 0.9

< 0.5

Haematology

Haemorrhage

none

mild, no

gross, 1 - 2 units transfusion per episode

gross, 3 - 4 units transfusion per episode

massive, > 4 units transfusion per episode

Coagulatio

Fibrinogen

WNL

0.99 - 0.75 x N

0.74 - 0.50 x N

0.49 - 0.25 x N

< 0.25 x N

Coagulatio

Prothrombin time(Quick)

WNL

1.01 - 1.25 x N

1.26 - 1.50 x N

1.51 - 2.00 x N

> 2.00 x N

Coagulatio

Partial thrombo- plastin time

WNL

1.01 - 1.66 x N

1.67 - 2.33 x N

2.34 - 3.00 x N

> 3.00 x N

Metabolic

Hyperglycaemia (mg/dl)

< 116

116 - 160

161 - 250

251 - 500

> 500 or ketoacidosis

Metabolic

Hypoglycaemia (mg/dl)

> 64

55 - 64

40 - 54

30 - 39

< 30

Metabolic

Amylase

WNL

< 1.5 x N

1.5 - 2.0 x N

2.1 - 5.0 N

> 5.0 x N

Metabolic

Hypercalcaemia (mg/dl)

< 10.6

10.6 - 11.5

11.6 - 12.5

12.6 - 13.4

13.5

Metabolic

Hypocalcaemia (mg/dl)

> 8.4

8.4 - 7.8

7.7 - 7.0

6.9 - 6.1

6

Metabolic

Hypomagnesaemia (mg/dl)

> 1.4

1.4 - 1.2

1.1 - 0.9

0.8 - 0.6

0.5

Gastrointestinal

Nausea

none

able to eat

intake

no significant

__

Gastrointestinal

Vomiting

none

1 episode in 24 hrs

2 - 5 episodes in 24 hrs

6 - 10 episodes in 24 hrs

> 10 episodes in 24 hrs or requiring paren- teral support

Gastrointestinal

Diarrhoea

none

increase of 2 - 3 stools / day over pre-Rx

increase of 4 -6 stools / day, or nocturnal stools, or moderate cramping

increase of 7 - 9 stools / day, or incontinence, or severe cramping

increase of > 10 stools / day or grossly bloody diarrhoea, or need for paren-teral support

Gastrointestinal

Stomatitis

none

painless ulcers, erythema, or mild soreness

painful erythema, oedema, or ulcers but can eat solids

painful erythema, oedema, or ulcers and cannot eat solids

requires paren-teral or enteral support for alimentation

Liver

Bilirubin (N = 17 μmol/L)

WNL

-----

< 1.5 x N

1.5 - 3.0 x N

> 3.0 x N

Liver

Transaminase (SGOT, SGPT)

WNL

2.5 x N

2.6 - 5.0 x N

5.1 - 20.0 x N

> 20.0 x N

Liver

Alk Phos or 5 nucleotidase

WNL

< 2.5 x N

2.6 - 5.0 x N

5.1 - 20.0 x N

> 20.0 x N

Liver

Liver- clinical

No change from baseline

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precoma

hepatic coma

Kidney, bladder

Creatinine

WNL

< 1.5 x N

1.5 - 3.0 x N

3.1 - 6.0 x N

> 6.0 x N

Kidney, bladder

Proteinuria

No change

1 (+) or < 0.3 g% or 3 g/L

2 - 3 (+) or 0.3 - 1.0 g% or 3 - 10 g/L

4 (+) or > 1.0 g% or > 10g/L

nephrotic syndrome

Kidney, bladder

Haematuria

Negative

microscopic only

gross, no clots no Rx needed

gross and clots bladder irrigation

requires trans- fusion or cystectomy

Kidney,

Weight gain/ loss

< 5.0 %

5.0 - 9.9 %

10.0 -19.9 %

20.00%

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Pulmonary

Pulmonary

none or no change

asymptomatic, with abnormal- ity in PFTs

dyspnoea on significant exertion

dyspnoea at normal level of activity

dyspnoea at rest

Cardiac

Cardiac arrhythmias

none

asymptomatic, transient, requiring no therapy

recurrent or persistent, no therapy required

requires treatment

requires moni- toring; or hypo- tension, or ventricular tachycardia or fibrillation

Cardiac

Cardiac function

none

asymptomatic, decline of resting ejection fraction by less than 20 % of baseline value

asymptomatic, decline of resting ejection fraction by more than 20 % of baseline value

mild CHF, responsive to therapy

severe of refractory CHF

Cardiac

Cardiac ischaemia

none

non-specific T- wave flattening

asymptomatic, ST and T wave changes suggesting ischaemia

angina without evidence of infraction

acute myocardial infarction

Cardiac

Cardiac- pericardial

none

asymptomatic effusion, no itervention required

pericarditis (rub, chest pain, ECG changes)

symptomatic effusion; drainage required

tamponade; drainage urgently required

Cardiac

Hypertension

none or no change

asymptomatic, transient increase by greater than 20 mm Hg (D) or to > 150 / 100 if previously WNL. No treatment required.

recurrent or persistent increase by greater than 20 mm HG (D) or to > 150 / 100 if previously WNL. No treatment required.

requires therapy

hypertensive crisis

Cardiac

Hypotension

none or no change

changes requiring no therapy (incl-

requires fluid replacement

requires therapy and

requires therapy and

Neurologic

Neuro: sensory

none or no change

mild paraesthesias; loss of deep tendon reflexes

mild or moderate objective sensory loss moderate paraesthesias

severe objective sensory loss or paraesthesias that interfere with function

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Neurologic

Neuro: motor

none or no change

subjective weak- ness; no objective findings

mild objective weakness without significant impair- ment of function

objektive weak- ness with impairment of function

paralysis

Neurologic

Neuro: cortical

none

mild somnolence or agitation

moderate somnolence or agitation

severe somnolence, (>50 % waking hours), agitation, confusion, disorientation or hallucinations

coma, seizures, toxic psychosis

Neurologic

Neuro: cerebellar

none

slight incoordination, dysdiadochokinesia

intention tremor, dysmetria, slurred speech, nystagmus

locomotor ataxia

cerebellar necrosis

Neurologic

Neuro: mood

no change

mild anxiety or depression

moderate anxiety or depression

severe anxiety or depression

suicidal ideation

Neurologic

Neuro: headache

none

mild

moderate or severe but transient

unrelenting and severe

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Neurologic

Neuro: constipation

none or no change

mild

moderate

severe

ileus > 96 hrs

Neurologic

Neuro: hearing

none or no change

asymptomatic, hearing loss on audiometry only

tinnitus

hearing loss interfering with function but correctable with hearing aid

deafness not correctable

Neurologic

Neuro: vision

none or no change

-----

-----

symptomatic subtotal loss of vision

blindness

Pain

Pain

none

mild

moderate

severe

reg. narcotics

Skin

Skin

none or no change

scattered macular ot papular eruption or erythema that is asymptomatic

scattered macular or papular eruption or erythema with pruritus or other associated symptoms

generalised symptomatic macular, papular or vesicular eruption

exfoliative dermatitis or ulcerating dermatitis

Alopecia

Alopecia

no loss

mild hair loss

pronounced or total hair loss

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Allergy

Allergy

none

transient rash, drug fever < 38oC (100.4oF)

urticaria, drug fever 38oC (100.4oF), mild bronchospasm

serum sickness, bronchospasm requiring parenteral medication

anaphylaxis

Local

Local

none

pain

pain and swelling with inflammation or phlebitis

ulceration

plastic surgery indicated

Fever of unknown origin

Fever of unknown origin

none

37.1 - 38.0o C 98.7o - 100.4o F

38.1 - 40.0oC 100.5 -104oF

> 40.0oC > 104.0oF for less than 24hrs

> 40.0oC (>104oF) for more than 24 hrs or accompanied by hypotension

Infection

Infection

none

mild

moderate

severe

life-threatening