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The symptoms of a moderate acute overdose on methylphenidate primarily arise from central nervous system overstimulation; these symptoms include: vomiting , agitation , tremors , hyperreflexia , muscle twitching, euphoria , confusion, hallucinations, delirium , hyperthermia , sweating, flushing , headache, tachycardia , heart palpitations , cardiac arrhythmias , hypertension , mydriasis , and dryness of mucous membranes .   A severe overdose may involve symptoms such as hyperpyrexia , sympathomimetic toxidrome , convulsions , paranoia , stereotypy (a repetitive movement disorder), rapid muscle breakdown , coma , and circulatory collapse .    A methylphenidate overdose is rarely fatal with appropriate care.  Severe toxic reactions involving abscess and necrosis have been reported following injection of methylphenidate tablets into an artery .