Reactions 795 - 1 Apr 2000

STheophylline overdose

Hyperglycaemia, acidosis and ketonuria in a child:case report

A 5-year-old boy developed hyperglycaemia, acidosis andketonuria following accidental ingestion of theophylline[dosenot stated].

The boy was hospitalised with abdominal pain and nauseaand was vomiting blood 4 hours after eating a light meal. Hehad a HR of 163 beats/min and a glucose level of 7.2 mmol/L.Glucose 5% and electrolytes were infused intravenously, andhe underwent iced saline gastric lavage and received antacidtherapy. An upper endoscopy performed 12h later revealed ahiatal hernia and gastritis. Urinalysis revealed glycosuria (50 g/dl) and maximal ketonuria. A blood chemical analysis showedan elevated blood glucose level (14.6 mmol/L) and a lowbicarbonate level (11.6 mEq/L); he also showed signs ofextracellular dehydration.

Diabetic ketoacidosis was diagnosed and the patient wastreated with fluids and regular insulin infusions. His bloodglucose level fell rapidly over the next 36 hours and insulindoses were decreased accordingly until they were no longerrequired. Drug poisoning was suspected at this stage on thebasis of persistent tachycardia. Tests revealed a theophyllineblood concentration of 16 µmol/L. The initial concentrationwas calculated by extrapolation to be 1024 µmol/L(therapeutic range 55–110). A final diagnosis ofhyperglycaemia, acidosis and ketonuria due to accidentaltheophylline ingestion was made.

Oral and intravenous glucose tolerence tests wereperformed 6 days later and were normal. Tests for immunepre-diabetic markers were negative. Glucose tolerance testsperformed after a 4 year-follow up period were still normal.

Author comment: Acute theophylline poisoning should beconsidered in cases presenting as hyperglycaemia, acidosis, andketonuria characterised by a rapid decrease in insulinrequirements.Polak M, et al. Theophylline intoxication mimicking diabetic ketoacidosis in achild. Diabetes and Metabolism 25: 513-515, Dec 1999 - France 807201293

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Reactions 1 Apr 2000 No. 7950114-9954/10/0795-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved