Theophylline overdose Hypokalaemia and respiratory alkalosis

A 30-day-old female was discharged from hospital on theophylline elixir 4.0mg every 8 hours to control excessive periodic breathing. She was the third born of triplets. delivered by primary Caesarean section at 32 weeks' gestation (birth weight 1380g) and had required ventilatory support for hyaline membrane disease

Four days after discharge. she was presented to hospital with a history of irritability and poor feeding. Her serum theophylline level was 97 mg/L. It was discovered that her father had mistakenly been giving her theophylline 40mg every 8 hours, a 10-fold overdose. On admission. she showed tachycardia (208 beats/min) and tachypnoea (136 breaths/min) but there were no clinical signs of seizure activity She was also found to have a respiratory alkalOSIS (pH 7 58. P .CO. 20mm Hg, HCO, 19 mEq/L) and hypokalaemla (serum potassium 2.2 mEq/L)

Treatment consisted of activated charcoal 2 g/kg 4-hourly and magnesium citrate 7 5ml but these were discontinued when the patient developed Ileus The hypokalaemia was then treated with IV potassium chlOride and she was discharged on no medications 6 days after admission

Parent-Induced overdosing of neonates should be preventable If changes In administration techniques or In drug formulations are avoided Strauss 44 Modan/ou HO Komatsu G PecfiatriC Pharmacology 5 209212 IVo 3 1985

0157-7271/86/1026-0011/0$01.00/0 © ADIS Press Reactions - 8 Mar 1986 11