Theophylline overdose Reversal with propranolol

Theophylline overdosage is a potentially fatal situation and the hypokalaemia which accompanies this toxicity is usually treated with IV potassium chloride. However, it has been shown that the {:I-blocker propranolol can raise serum potassium levels and , thus, the drug has the poten tial to be a suitable antidote in theophylline poisoning.

A 14-year-old non-asthmatic girl swallowed an unknown quantity of tablets containing codeine, paracetamol. bendrofluazide and slow release theophylline . None of the medication was her own and 8 hours later she was admitted drowsy and vomiting blood, wi th a temperature of 33.5° C, BP of 110/65mm Hg, a pulse of 90 beats/min and respiration of 25/min. Her abdominal region was tender , the serum potassium level was 2.2 mmol/L and plasma glucose was 14 mmoljL. Her plasma theophylline level was > 4 t imes higher than any value in the therapeu tic range (86 instead of 10-20 mg/L).

IV propranolol 10mg was infused over 1 hour and the patien t recovered with heart rate and plasma glucose decreasing to normal. BP rising and serum potassium increasing to 3.6 mmol/L.

Propranolol corrected the hyperglycaemia, another constant finding of theophylline overdosage, possibly by an effect on pancreatic glucagon secretion. In conclusion' , , , propranolol reversed hypokalaemia a nd hyperglycaemia a nd improved the haemodynamic state ' , Thus, 'beta­adrenerg ic blockade may be of benefit in the management of theophylline overdosage. especially in the non­asthmatic patient. and possibly also in the asthmatic patient with severe hypokalaemia or cardiac arrhythmias', Amin, DN and Henry, J A Lancet 1. 520·521 (2 Mar 1985)