Reactions 417 - 5 Sep 1992

STheophylline overdose

Fatal rhabdomyolysis and acute compartmentsyndrome: case report

Agitation and tachycardia with epigastric tendernessdeveloped in a 24-year-old man who had mistakenly ingestedtheophylline 8g instead of analgesics. On admission [timesince drug ingestion not specified], he had several metabolicabnormalities including profound hypokalaemia. His serumtheophylline level was 162 mg/ml and enteral charcoal wasadministered.

Three hours later, the patient had a grand mal seizurefollowed by 2 cardiac arrests from which he was successfullyresuscitated. However, he subsequently developed a clinicalpicture suggestive of acute lower limb compartmentsyndrome; renal failure was also established.

Charcoal haemoperfusion improved the patient’shaemodynamic status and lowered the serum theophyllinelevel to 63 mg/ml. His tense anterior, posterior and peronealcompartments were bilaterally decompressed.Postoperatively, the patient was inotrope- and haemodialysis-dependent.

Heparin-induced bleeding developed at fasciotomy sites,and continued despite administration of IV protamine andlarge quantities of blood products. The patient’s arms becametense and swollen with poor radial pulses 28 hours afteradmission. Compartment syndrome was diagnosed and thepatient died 4 hours later.

Author comment: Rhabdomyolysis has been described atleast 5 times previously in association with theophyllineoverdose and there has been 1 report similar to the present casewhere the clinical picture was complicated by acutecompartment syndrome. The profound hypokalaemia andgrand mal seizures were probably synergistic in causing severerhabdomyolysis which resulted in renal failure and acutecompartment syndrome.Titley OG, et al. Theophylline toxicity causing rhabdomyolysis and acutecompartment syndrome. Intensive Care Medicine 18: 129-130, Apr 1992 -England 800144710

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Reactions 5 Sep 1992 No. 4170114-9954/10/0417-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved