Reactions 470 - 25 Sep 1993

STheophylline overdose

Hypotension: case reportSevere vasopressor-resistant hypotension caused the death

of a 52-year-old man after the ingestion of an unknownquantity of theophylline, which had been prescribed for hiswife. The patient had a history of hypertension, which hadbeen treated with hydrochlorothiazide and lisinopril.

The man presented with severe hypotension, abnormalelectrolyte levels, an elevated WBC count and cardiacarrhythmias. His serum theophylline concentration was 1275µmol/L. The patient died 48 hours after admission despiteemergency intubation, cardioversion, haemoperfusion, IVfluids, epinephrine [adrenaline], phenylephrine, digoxin,adenosine, lorazepam, activated charcoal, diazepam,pentobarbital and propranolol.

Author comment: ‘In addition to the usual clinicalmanifestations of theophylline toxicity, severe, prolongedhypotension can occur and prove refractory to commonly usedvasopressors. This points to the importance of earlyidentification and treatment of theophylline poisoning,including using higher than conventionally recommendeddoses of vasopressors if deemed necessary to prevent thedevelopment of serious sequelae.’Dettloff RW, et al. Vasopressor-resistant hypotension following a massiveingestion of theophylline. Annals of Pharmacotherapy 27: 781-784, Jun 1993 -USA 800217515

1

Reactions 25 Sep 1993 No. 4700114-9954/10/0470-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved