Theopylline overdose First report of primary T wave abnormalities: case report

Progressive dyspnoea and wheezing developed in a 33-year-old woman with a history of asthma. She took theophylline 2400 g over 8 hours in an attempt to resolve her symptoms, and presented with nausea, tremors and palpitations the following day . The patient smoked cigarettes (1 pack/ day) and admitted occasional cocaine use. Her asthma was usually controlled with theophylline 300 mg bid .

Upon presentation she was hypotensive with an elevated respiratory rate . She was alert , oriented but anxIOUS With a fine resting tremor and symmetric hyperreflexia. ECG revealed T wave inversion in leads 2, 3. aVF and V,-V6. Serum theophylline levels were reduced by activated charcoal and magnesium citrate administration and a repeat ECG showed nearly complete resolution of the T wave inversion.

The authors suggested that the patient may have had underlying sinus node dysfunction or relative autonomic dysfunction secondary to cocaine use, leading to prevention of the usual tachycardia associated with theophylline toxici ty . The relative bradycardia then unmasked centrally induced repolarisation abnormalities caused by theophylline toxici ty .

'One should therefore be alerted to possible electrocardiographic changes in severe theophylline toxicity '.

Kolander SA. Nydegger CC. Porter RS T wave InverSion associated With severe theophylhne toxIcity Chest 96' 429-43t . Aug '989 99"

Tachycardia: case report Schwartz MP. Taylor AT Multi-drug theophylline overdose Journal of Family Practice 28' 575-577 .

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