Reactions 428 - 21 Nov 1992

STheophylline overdose

Gastric bezoar: case reportA lethargic and somewhat somnolent 54-year-old woman

was taken to an emergency department after ingesting ‘largeamounts’ of theophylline [(Theo-Dur® and Motrin®); exactdose not documented] and alcohol in a suicide attempt.[Duration between ingestion and admission not given].

Oxygen and IV saline were administered and the patientunderwent gastric lavage (no pill fragments recovered).Activated charcoal and magnesium citrate were alsoadministered. Her serum theophylline level was 31.3 mg/L anda compensated chronic respiratory alkalosis was apparent.Manifestations of mild toxicity resolved.

The patient arrested and died 8 hours after discharge fromthe emergency department. A 318.8g white waxy mass mixedwith charcoal (gastric pharmacobezoar), and containing 29g oftheophylline, was found in the patient’s stomach at autopsy.The serum theophylline level was 190.1 mg/L.

Author comment: ‘Gastric pharmacobezoar after theingestion of sustained-release theophylline has not beenreported previously in the US literature . . . In treating sustained-release theophylline overdoses, physicians should consider thepossibility that an unevacuated but accessible concretion ofdrug may be acting as a source of continued drug absorption.’Bernstein G, et al. Failure of gastric emptying and charcoal administration in fatalsustained-release theophylline overdose: pharmacobezoar formation. Annals ofEmergency Medicine 21: 1388-1390, Nov 1992 - USA 800164796

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Reactions 21 Nov 1992 No. 4280114-9954/10/0428-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved