Substance
- theophylline
intoxication.
- (45.5%)
had acute, (40.4%) had chronic, and (14.0%) had acute-on-therapeutic poisoning.
[1]
Common name or Trade name
- definition:
Therapeutic ranges are usually achieved between 10–20 μg/mL. Toxic effects are
often seen above 20 μg/mL plasma concentrations. [2]
Involving system
-
Effect: diuretic, smooth muscle relaxant, cardiac,
nervous system, and ventilator stimulant [2]
-
GI system: nausea, vomiting, gastrointestinal reflux [2]
-
Neuro: restlessness, and headache, convulsions (8.2%) [2, 3]
-
CV: severe cardiac arrhythmias (20.8%), hypotension (may
result fromβ2-stimulated peripheral vasodilation) and even death occur at
higher theophylline concentrations (usually 80–100 μg/mL). [1, 2]
Presentation
-
severe cardiac arrhythmias, refractory hypotension, and
convulsions [2]
-
Hypokalemia, hypercalcemia, hyperglycemia, and acidosis
are metabolic disturbances that commonly occur after an acute overdose [2]
-
May complicate with Coma Blister. [4]
Antidote and
Treatment
-
Gastrointestinal decontamination with activated charcoal.
[2]
-
The use of beta-blockers is an acceptable approach to
control tachydysrhythmias [2]
-
aggressive fluid administration + conventional
vasopressors in cases of refractory hypotension.
-
-
standard hemodialysis is a suitable alternative when
severe theophylline toxicity [2].
Disposition
-
Carefully DDx with a thyroid storm.
-
4.2% fatality [D].
REFERENCES
[1]. Shannon M. Life-threatening events after theophylline
overdose: a 10-year prospective analysis. Arch Intern Med. 1999 May
10;159(9):989-94. doi: 10.1001/archinte.159.9.989. PMID: 10326941.
[2]. Aggelopoulou E, Tzortzis S, Tsiourantani F, Agrios I,
Lazaridis K. Atrial Fibrillation and Shock: Unmasking Theophylline Toxicity.
Med Princ Pract. 2018;27(4):387-391. doi: 10.1159/000490145. Epub 2018 Jun 22.
PMID: 29936503; PMCID: PMC6170900.
[3]. Kopacz P, Kula K. Lethal poisoning
with theophylline in the form of rectally administered tablets. Arch Med
Sadowej Kryminol. 2014;64(3):158-64. doi: 10.5114/amsik.2014.48879. PMID:
25693173.
[4]. Tsokos M, Sperhake JP. Coma blisters
in a case of fatal theophylline intoxication. Am J Forensic Med Pathol. 2002
Sep;23(3):292-4. doi: 10.1097/00000433-200209000-00019. PMID: 12198361.
edited by Yu-Jang Su
Dec 7, 2021