Reactions 547 - 22 Apr 1995

STheophylline overdose

Death: case reportActivated charcoal administration was unable to prevent a

rise in theophylline blood concentrations in a 38-year-old manwho took a fatal overdose of the agent. However, theophyllineconcentrations were reduced with a combination ofhaemoperfusion and haemodialysis.

The man presented with sinus tachycardia andhypokalaemia 6 hours after he ingested approximately 100tablets of slow-release theophylline 250mg [‘UniphyllinContinus’]. Ten hours later he developed tachycardia, seizuresand cardiac arrest that responded to cardioversion. His bloodconcentration of theophylline was 183 mg/L.

Despite treatment with activated charcoal 200g followed by50g 2-hourly, the man’s theophylline concentration hadincreased to 192 mg/L 17 hours after admission. He developedcontinual seizures, supraventricular tachycardia, respiratoryarrest, shock and oliguria, and his core temperature was41.8°C. He was intubated and ventilated and treated with IVepinephrine [adrenaline] and norepinephrine [noradrenaline].

Charcoal haemoperfusion was started 25 hours after theoverdose; hydrocortisone and chlorpheniramine were given atthe start of this procedure. After 4 hours of haemoperfusion,the man’s theophylline concentration had decreased to 36mg/L. The following morning continuous arteriovenoushaemodialysis was started because of a rebound intheophylline concentrations; after 40 hours’ treatment histheophylline concentration had decreased from 78 to 49 mg/L.After a second treatment with charcoal haemoperfusion, thisconcentration decreased to < 10 mg/L.

The man had irreversible brain damage and died 3 weeksafter the overdose.

Author comment: Charcoal haemoperfusion is thetreatment of choice in cases of severe theophylline poisoning. Ifthis is not available, haemodialysis alone may be effective.Higgins RM, et al. Severe theophylline poisoning: charcoal haemoperfusion orhaemodialysis? Postgraduate Medical Journal 71: 224-226, Apr 1995 -England 800354868

1

Reactions 22 Apr 1995 No. 5470114-9954/10/0547-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved