Theophylline overdose Bezoar

A flushed, tremulous, agitated but fully conscious patient presented 2-3 hours after ingesting about 60 slow release theophylline tablets 300mg. Examination revealed sinus tachycardia (132 beats/min), hypokalaemia (serum potassium 2.5 mmol/L) and a serum theophylline level of 350 j.lmol/L.

Oral activated charcoal 50g and IV saline and potassium chloride were administered after gastric lavage failed to yield any tablet particles.

The patient became increasingly agitated and tremulous, vomiting developed, and heart rate increased to 150-160 beats/min over the next 12 hours with the theophylline level rising to 490 j.lmol/L 12 hours post-admission.

A white bolus of congealed tablets 2cm in diameter in the greater curvature of the stomach was revealed on gastroscopy. This was removed in a Dormia basket, the stomach was irrigated with a water jet and visible particles were aspirated. Oral mannitol 20g in 2L of water followed over 2 hours. The theophylline concentration had fallen to 312 j.lmol/L 3 hours after endoscopy and symptoms resolved over the following 12 hours. Cereda J. Scott J, Quigley EMM. British Medical Journal293 1143, 1 Nov 1986

10 Reactions'" 22 Nov 1986 0157-7271/86/1122-0010/0$01.00/0 @ADIS Press