Theophylline overdose GastrOintestinal and cardiovascular complications

22 episodes of hospitalisation for inadvertent oral theophylline intoxication were reviewed. Maximum serum theophyUine levels ranged from 22.4 to 104.8 mg/l. Gastrointestinal tract complaints, including anorexia, nausea, vomiting, abdominal pain and diarrhoea were the most frequent toxic effects. Three patients had generalised grand mal seizures wh'lch persisted from 3-11 hours and were refractory to treatment with IV phenytoin and diazepam. 20 of the 22 episodes were associated with ECG abnormalities. Sinus tachycardia alone was present in 9 episodes, whereas multiple premature ventricular or atrial contractions were present in 6 episodes. An additional 5 episodes were associated with supraventricular arrhythmias. With reduction of theoPhyJline levels all ECG abnormalities resolved. The most common cause ot intoxication was excessive drug ingestion by the patient. In 9 of 22 episodes physician error (excessive dose prescription, unrecognized drug interactions) was the primary mechanism of toxicity. Duration of hospitalisation ranged from 2-15 days. Therapeutic intervention was limited to induction of emesis, administration of cathartics and activated charcoal. Charcoal haemoperfusion or dialysis was not utilized. Inadvertant oral theophylline intoxication can be minimised with appropralte patient education, as well as a better understanding at theophylline kinetiCS and potential drug interactions. Mounta.in, RD. a.nd Neff. fA.: Archives of Internal Medicine 144. 124 (Apr 1984)

(J157.7271/84/D623.lJ009/0$01.00/0 @ ADIS Press Reactions 23 Jun 1984 9