Reactions 1241 - 28 Feb 2009

O STheophylline overdose

Acute pancreatitis: case reportA 39-year-old man developed acute pancreatitis after

ingesting an overdose of theophylline.The man intentionally ingested 20 tablets of sustained-

release theophylline [strength not stated] and presented toan emergency department. Four hours post-ingestion hewas thirsty and restless with nausea, vomiting andpalpitations; he had supraventricular tachycardia (HR198 bpm) and hypoactive bowel sounds. His serumtheophylline concentration was 777 µmol/L.

The man’s tachycardia did not respond to adenosine anddiltiazem, and no significant tablet fragments werereturned upon gastric lavage. He had a tonic-clonic seizure2 hours after admission. He was intubated and underwentcharcoal haemoperfusion; his heart rate decreased to114 bpm. On day 2 he developed signs of rhabdomyolysisand acute renal failure, but had improved by day 4. Hereported worsening abdominal pain on day 5, with low-grade fever. Endoscopy showed oesophageal ulcers andlaboratory tests revealed a serum amylase level of 386 U/Land a serum lipase level of 2574 U/L. Enlargement of thepancreas was evident on ultrasound and CT. He improvedover the next 48 hours with supportive care, fluidreplacement and parenteral nutrition, and was dischargedin good condition.

Author comment: "The temporal relationship of the acutepancreatitis with the theophylline intoxication supports thediagnosis of theophylline-related pancreatitis."Liu PH, et al. Acute pancreatitis after severe theophylline overdose. ClinicalToxicology 46: 1103, No. 10, Dec 2008 - Taiwan 801135855

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Reactions 28 Feb 2009 No. 12410114-9954/10/1241-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved