Which symptom is a late manifestation of bupivacaine overdose?

Auditory hallucinations are indeed a late manifestation of bupivacaine overdose, primarily due to the drug's effect on the central nervous system. Bupivacaine is a local anesthetic that can lead to systemic toxicity, especially when absorbed in excess levels into the bloodstream. As toxicity progresses, various neurological symptoms can emerge.

Initially, these symptoms may present as mild central nervous system stimulation, including symptoms such as anxiety or restlessness. However, as levels of the drug increase, neurotoxicity can manifest more severely, leading to altered mental status, including confusion, seizures, and hallucinations. Auditory hallucinations specifically can occur as the CNS becomes significantly affected by the anesthetic, marking a notable shift from initial stimulation to a more severe state of depression or disturbance.

While hypertension, fever, and diarrhea may occur at different stages or in various contexts, they are not recognized as direct indicators or symptoms of late-stage bupivacaine toxicity. Instead, they may relate to other physiological responses or conditions not specifically connected to the central nervous system effects resulting from bupivacaine overdose. Thus, auditory hallucinations serve as a clearer and more specific indicator of severe toxicity associated with bupivacaine.