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]
Leading experts from Latin America, Africa, Near and Middle East, Indian Subcontinent, Far East, Oceania and Australia present their expert insights into specific conditions, as well as progress and challenges in the development of the specialty. [books.google.de]
Cardiovascular
- Hypotension
CAVEAT: Barbiturates can precipitate hypotension. Phenobarbital has the added advantage of enhancing the hepatic metabolism of theophylline. [emedicine.medscape.com]
Clinical features included nausea, tremor, delirium, hypotension and cardiac arrhythmias, metabolic acidosis, hyperglycemia, hypokalemia and hypophosphatemia. [ncbi.nlm.nih.gov]
Severe intoxication is characterized by ventricular and supraventricular tachyarrhythmias, hypotension, and seizures. Status epilepticus is common and often intractable to the usual anticonvulsants. [accessmedicine.mhmedical.com]
Face, Head & Neck
- Facial Spasm
Two days following admission, the patient developed facial spasms and twitching of her muscles of her upper limbs. Over the next 24 hours, the patient had two witnessed tonic-clonic seizures, which were terminated with intravenous Lorazepam. [bjmp.org]
Neurologic
- Agitation
• CVS: palpitation and hypotension • CNS: Tremors, agitation, restlessness, seizures and coma in late severe stages. • Respiratory: Tachypnea 5. Take Care!! [fr.slideshare.net]
Toxicity is characterised by agitation, tremor, nausea, vomiting, abdominal pains, seizures, and tachyarrhythmias. Hypokalaemia and metabolic acidosis are more profound in acute toxicity, and hypercalcaemia is usually present. [ncbi.nlm.nih.gov]
Neurologic findings commonly include tremors, restlessness, agitation, and seizures. Gastrointestinal findings include nausea, vomiting, abdominal pain, and diarrhea. Causes Acute toxicity occurs with accidental or intentional overdose. [emedicine.medscape.com]
Workup
[…] fibrillation, supraventricular tachycardia, hypotension, cardiac arrest Respiratory: Tachypnea, acute lung injury, respiratory alkalosis Gastrointestinal (GI): Nausea, vomiting, abdominal pain Neurological: Tremors, hallucinations, seizures[1][3] Evaluation Workup [ncbi.nlm.nih.gov]
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
Following completion of an 8 h MARS treatment plasma theophylline levels remained low, although it was necessary to administer intravenous potassium and magnesium supplements. Fig. 1. Plasma theophylline levels in response to MARS treatment. Fig. 1. [academic.oup.com]
It is a very effective method of elimination, and it is considered the mainstay treatment of theophylline toxicity. It is important to aggressively control nausea and vomiting in order to perform MDAC treatment. [emedicine.medscape.com]
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]
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]
The clinical manifestations of toxicity are fundamentally gastrointestinal, cardiovascular, neurologic and metabolic with some being of specially severity, conditioning the prognosis of the intoxication. [archbronconeumol.org]
Etiology
Emergency department providers should become familiar with managing patients with theophylline toxicity since arrhythmias, seizures, hyperglycemia, and rhabdomyolysis are several of the complications that can arise.[1][2][3] Etiology Theophylline has [ncbi.nlm.nih.gov]
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]
Epidemiology Toxic exposures to theophylline have decreased significantly since its management for asthma and COPD has declined. [ncbi.nlm.nih.gov]
Indications a wide range p.810 of epidemiologic and microbiologic flora. An alternative approach. [smj.org.sa]
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]
Because several pathophysiologic factors can increase the risk of toxicity, the clinician often must rely on other laboratory tests, such as electrolytes and renal function, to monitor the patient effectively. [academic.oup.com]
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
Prevention of gastrointestinal absorption should be the principal objective of treatment of an oral theophylline poisoning. [ncbi.nlm.nih.gov]
[…] theophylline toxicity Reference - National Heart, Lung, and Blood Institute (NHLBI) National Asthma Education and Prevention Program guideline on diagnosis and management of asthma (NHLBI 2007 OpenInNewPDF PictureAsPdf, or at 17983880J Allergy Clin Immunol [dynamed.com]
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]