Reactions 1221 - 27 Sep 2008

O STheophylline overdose

Hypokalaemia, arrhythmias and metabolicdisorders: case report

A 17-year-old girl developed hypokalaemia, arrhythmias andmetabolic disorders after intentionally ingesting an overdoseof theophylline [Afonilum] in a suicide attempt.

The girl swallowed an unknown quantity of theophylline250mg tablets, which were probably in a sustained releaseform. Spontaneous vomiting was reported after about30 minutes, then 3 hours later, she presented with apparentpalpitations, nausea and vomiting. Her BP was 116/50 mmHg,heart rate 88 beats/min and laboratory tests revealedhyperglycaemia, metabolic alkalosis, hypokalaemia(1.86 mmol/L), elevated myoglobin and creatine kinase levelsand a theophylline level of 44 mg/L. She was hospitalised afterECG showed prolongation of the QTc interval and extraventricular systoles. Her theophylline level reached 68 mg/L,the risk of ventricular arrhythmia increased and she wastransferred to ICU. Further laboratory tests showed signs ofmetabolic alkalosis and she began to hyperventilate.

The girl received mechanical ventilation and parentalpotassium. However, due to persistent hypokalaemia shebegan receiving oral potassium. Her clinical conditionimproved 24 hours after overdosing. Although she hadrecovered 72 hours after hospitalisation, hypokalaemia andmetabolic alkalosis persisted. After being discharged in goodhealth, she continued to receive potassium for persistenthypokalaemia and was monitored as an outpatient.

Author comment: In our case, arrhythmia was apparentlyrelated to severe hypokalaemia and peak levels oftheophylline.Tesfaye H, et al. Hypokalaemia in a suicide attempt of an adolescent girl. CasopisLekaru Ceskych 147: 333-336, No. 6, 2008 [Czech; summarised from atranslation] - Czech Republic 801117870

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Reactions 27 Sep 2008 No. 12210114-9954/10/1221-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved