Theophylline overdose Infantile Intracranial hemorrhage with ..".,. neurological .. quelae

A 2-year-old boy with viral bronchiolitis received oral theophylline 50mg qid (33 mg/kg/day).

Generalised seizures developed and the child was given IV diazepam and phenobarbital. After an initial clear lumbar puncture, a repeat lumbar puncture 6 hours after the last theophylline dose (serum theophylline 42.4 mg/ml) revealed grossly bloody CSF. A severe intracranial haemorrhage was shown on CT scan. There was no clinical or laboratory evidence of intracranial viral or bacterial infection, trauma, vascular disease or coagulopathy. Sequelae included quadriparesis, a mixed seizure disorder, communicating hydrocephalus and porencephaly.

Intracranial haemorrhage in this infant was most likely to have been caused by theophylline, although other unknown factors may have been involved.

Since life-threatening neurotoxicity can result from theophylline dose miscalculations and unpredictable pharmacokinetics in infants, caution must be used in the selection of infants for treatment, administration of theophylline, and evaluation and treatment of toxicity. Woody RC. Laney fA Developmental MedICine and Child Neurology 28 121·122. Feb 1986

0757-7271/86/7026.0009/0$07.00/0 @ADlS Press ReactiOll8- 26 April 1988 9