Reactions 626 - 9 Nov 1996

STheophylline overdose

Intestinal pseudo-obstruction: case reportA 45-year-old man with severe chronic obstructive

pulmonary disease was diagnosed with intestinal pseudo-obstruction (Ogilvie’s syndrome) after he ingested anoverdose of theophylline tablets.

The man was brought to hospital because of vomiting andconfusion. He had apparently taken 100 theophylline 300mgtablets; his theophylline concentration was 191 mg/L. Hiscardiac rhythm was multifocal atrial tachycardia. He wasadmitted to intensive care and treated with activated charcoal,metoclopramide and IV fluids with potassiumsupplementation. Haemodialysis was performed.

During the second hospital day, the man developed severerespiratory acidosis and mechanical ventilation was necessary.He was treated with clindamycin for purulent sputum andfever, and haloperidol for sedation. His potassium levelincreased to 6.5 meq/L and he was treated with sodiumpolystyrene sulfonate [‘Kayexalate’].

During the third hospital day, the man developed abdominaldistension, tenderness, leukocytosis and a persistent fever. Alaparotomy was performed and his caecum was found to bedilated to 16cm without any distal obstruction. A 6cm charcoalbezoar was found in his stomach. He was extubated on thesecond postoperative day and discharged 19 days after hisadmission.

Author comment: ‘We report the third case of Ogilvie’ssyndrome occurring in the setting of severe theophyllinetoxicity. Although the cause of decrease gut motility was likelymultifactorial, we believe that theophylline-inducedhypokalemia was the primary cause.’Brubacher JR, et al. Intestinal pseudo-obstruction (Ogilvie’s syndrome) intheophylline overdose. Veterinary and Human Toxicology 38: 368-370, Oct 1996 -USA 800478100

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Reactions 9 Nov 1996 No. 6260114-9954/10/0626-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved