Theophylline overdose·

PseudopancreatUis with hyperamylasaemia: first report A 53-year-old man with a history of chronic obstructive airways disease was admitted in a state of shock (pulse I SO/min; BP 90/S0mm Hg>tachypnoea, nausea and

complaints of epigastric and central abdominal pain. His previous medications included salbutamol (albuteroJ) and cimetidine ([or dyspepsia) which he had stopped taking 3 months before. Clinical ellamination revealed a distended abdomen, diminished bowel sounds and epigastric tenderness and a provisional diagnosis of overdosage was made. A coffee ground material was recovered on stomach aspiration. Subsequent laboratory examinations revealed leucocytosis, hypokalaemic metaboli.; acidosis, hyperglycaemia, glycosuria and hyperamylasaemia. Diagnosis was corrected to acute pancreatitis, and supportive treatment consisting of IV Ouids, blood, potassium, insulin and gastric aspiration. Was commenced. Tachycardia was controlled with IV verapamil. Nevertheless, [he patient's condition deteriorated and he died of cardiorespiratory arrest following grand mal convulsions. At postmortem coronary atherosclerosis and pulmonary oedema were evident. The stomach contained 30 partially dissolved tablets consisting of a combination of theophylline and ethylenediamine and SOOml of haemorrhagic fluid. The pancreas however was normal both macro and microscopically, but postmortem liver and blood Lheophylline concentrations were I 08mgII. and I OOmg/ L (therapeutic concentratJon being I O.20mg/ U respectively. In the present case. the source of amyla~e is unknown but is presumed to be the direcL result of theophylline intoxication, which GOuld be successfully treated with resin or charcoal haemoperfusion. When signs of apparent pancreatitis are evident in patients suffering from chronic obstructive airways disease, theophyLLine overdosage should be borne in mind. Burgan. T.H$. e\ aLe Br'li,n Medical Journal 2&4· QW

(27 Mar 19&21

Ot57-727t/82/0423-0007/0$01.00/0 © AD IS Press Reactions 23 Apr 1982 7