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Theophylline Poisoning

Theophylline Toxicity


Presentation

  • The nadir in serum potassium concentrations was more severe among 25 patients who presented to the emergency department within 6 hours of the overdose than among 13 patients who presented later (mean /- SE, 3.0 /- 0.1 mEq/L vs 3.4 /- 0.1 mEq/L, p less[ncbi.nlm.nih.gov]
  • Hypokalaemia and metabolic acidosis are more profound in acute toxicity, and hypercalcaemia is usually present. Seizures occur at lower concentrations after chronic over-medication than after acute overdose.[ncbi.nlm.nih.gov]
  • We present a case of acute theophylline overdose treated with esmolol under haemodynamic control. Haemodynamic monitoring was useful in determining the appropriate duration of administration of esmolol and in deciding on treatment with fluids.[ncbi.nlm.nih.gov]
  • Five cases are presented in which multiple doses of activated charcoal were given to infants 6 months of age or less, as treatment of theophylline overdose.[ncbi.nlm.nih.gov]
  • Three cases of theophylline poisoning in young children, two of which occurred after erroneous administration of commonly prescribed pediatric drugs, are presented.[ncbi.nlm.nih.gov]
Asymptomatic
  • He is currently asymptomatic with vital signs of T 37.0 C, P 110/min, BP 140/80 mmHg, So2 98% OA, and is GCS 15. Maybe staying free of theophylline is a good idea... Questions Q1. What is the risk assessment? The ingested dose is 100mg/kg.[lifeinthefastlane.com]
Aspiration
  • Dyspnoea is a serious symptom requiring causal and/or Aspiration of gastric contents while using the i-gel laryngeal mask: Case report of three cases The i-gel supraglottic airway is a second generation Atrial fibrillation in critically ill patients Arrhythmias[prolekare.cz]
  • It is also important that the patient is able to protect his or her airway in order to prevent aspiration of activated charcoal, which can be detrimental. Administer the cathartic, sorbitol, with the activated charcoal one time.[emedicine.medscape.com]
  • The airway of the patient must be covered prior to giving the charcoal in order to avoid aspiration. Electrolyte solution will also be administered to return them to normal levels.[overdoseinfo.com]
  • Serum theophylline levels continued to increase during the first 24 hours after admission so she was transferred to the intensive care unit (ICU) where she had a tonic-clonic seizure, aspirated, and required intubation and ventilation.[thorax.bmj.com]
Hypotension
  • Clinical features included nausea, tremor, delirium, hypotension and cardiac arrhythmias, metabolic acidosis, hyperglycemia, hypokalemia and hypophosphatemia.[ncbi.nlm.nih.gov]
  • CAVEAT: Barbiturates can precipitate hypotension. Phenobarbital has the added advantage of enhancing the hepatic metabolism of theophylline.[emedicine.medscape.com]
  • The low incidence of life-threatening manifestations of severe toxicity (hypotension, serious arrhythmias or seizures) and excellent outcome, contrasts with many previous reports.[ncbi.nlm.nih.gov]
  • The aggressive supplementation of potassium, treatment of emesis with droperidol and ranitidine, and treatment of tachyarrhythmias and hypotension (possibly with propranolol), together with oral multiple dose charcoal may obviate the need for haemoperfusion[ncbi.nlm.nih.gov]
  • Toxic levels of theophylline were associated with hypokalemia, hypophosphatemia, hyperglycemia, metabolic acidosis, and hypotension in both the patient and the experimental series.[annals.org]

Workup

  • An extensive workup excluded pre-diabetic status (Table I) . An oral glucose tolerance test performed 6 days later was normal, and insulin release evaluated by the intravenous glucose tolerance test was normal.[em-consulte.com]

Treatment

  • Use of multiple dose activated charcoal appears to be a viable option in the treatment of young infants with theophylline poisoning.[ncbi.nlm.nih.gov]
  • During combined treatment, the mean extraction rate of haemodialysis was 62%, compared with 48% for charcoal haemoperfusion.[ncbi.nlm.nih.gov]
  • The aggressive supplementation of potassium, treatment of emesis with droperidol and ranitidine, and treatment of tachyarrhythmias and hypotension (possibly with propranolol), together with oral multiple dose charcoal may obviate the need for haemoperfusion[ncbi.nlm.nih.gov]
  • Dantrolene appeared to be useful in controlling the hypermetabolic state associated with the overdose and may have a role in future treatment.[ncbi.nlm.nih.gov]
  • Haemodynamic monitoring was useful in determining the appropriate duration of administration of esmolol and in deciding on treatment with fluids.[ncbi.nlm.nih.gov]

Prognosis

  • Signs and symptoms range from mild gastrointestinal upset to serious central nervous system manifestations such as seizures, a symptom often associated with a bad prognosis.[ncbi.nlm.nih.gov]
  • Dysrhythmias and seizures are late features of severe theophyline toxicity and suggest a very poor prognosis. Q5. Should this man be transferred to another hospital? If so, why and how? This is a life-threatening acute ingestion of theophylline.[lifeinthefastlane.com]

Epidemiology

  • Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology[prolekare.cz]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Indications a wide range p.810 of epidemiologic and microbiologic flora. An alternative approach.[smj.org.sa]
Sex distribution
Age distribution

Pathophysiology

  • Therefore it is essential that clinicians are aware of the pathophysiology, clinical presentation and treatment of this poisoning. Theophylline intoxication mainly affects the gastrointestinal, cardiovascular and central nervous systems.[ncbi.nlm.nih.gov]
  • Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices.[books.google.de]
  • Pneumothorax anatomy and pathophysiology the auricle and the globe and resultant outcome of scalp wound closure to achieve precise approximation and repair chest wall are the landmarks and is achieved by the epiglottis with the moistened cotton-tipped[smj.org.sa]

Prevention

  • In summary, activated charcoal given by mouth may be unable to prevent a rise in blood levels and the development of complications after substantial theophylline overdose.[ncbi.nlm.nih.gov]
  • Prevention of gastrointestinal absorption should be the principal objective of treatment of an oral theophylline poisoning.[ncbi.nlm.nih.gov]
  • How to prevent Theophylline Toxicity? In order to prevent an overdose in theophylline, the medications must be taken as directed.[overdoseinfo.com]
  • These effects were either prevented or partially reversed after induction of beta-blockade with propranolol. Very high levels of theophylline were associated with elevated levels of norepinephrine and epinephrine in the animals. FULL TEXT[annals.org]
  • Haemofilter circuits were primed with a bolus of 5000 units heparin and clotting was subsequently prevented with 1000 units heparin per hour.[thorax.bmj.com]

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