Theophylline overdose Ketoacidosis: case report

A 19-year-old woman was hospitalised alter an overdose of slow­release theophyll ine 15g. She experienced vomiting, diarrhoea and was agitated . 24 hours postadmission tonic clonic seizures occurred followed by respiratory arrest. 30 hours postadmission the patient was comatose with sinus tachycardia of 170, systolic BP 60mm Hg and tachypnoea.

Laboratory measurement revealed a serum theophylline level of 125 mg/L; pH and serum glucose were elevated, while pC02 and P02 were decreased. Urinalysis revealed high urinary ketone concentration and the patient 's breath smelled strongly of ketones.

Following gastric lavage and treatment with activated charcoal , IV dextrose 10% and IV metoprolol 5mg (2 doses) , serum theophylline level decreased from 125 to 25 mg/ L and the patient became normotensive with resolution of respiratory alkalosis , metabolic acidosis and disappearance of ketone bodies from the breath and urine . Four days postadmission she was completely recovered and discharged. Ryan T, Coughlan G, McGing P, Phelan D. KetosIs , a complication of theophyll ine toxIcity Journal of Internal Medicine 22 277·278, Oct 1989

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