title: Failure of gastric emptying and charcoal administration in fatal sustained-release theophylline overdose: pharmacobezoar formation.
abstract: We report the case of a fatal theophylline overdose from a sustained-release preparation in a 54-year-old woman. Initial serum theophylline concentration was 31.3 mg/L. Manifestations of mild toxicity cleared in the emergency department after treatment with gastric lavage, charcoal, and a cathartic. A life-threatening overdose was not suspected, and the patient arrested eight hours after discharge from the ED. At autopsy, her serum theophylline concentration was 190.1 mg/L. A white, waxy mass weighing 318.8 g and containing 29 g theophylline, representing the residue of many sustained-release tablets, was found in her stomach. This case reinforces the importance of obtaining repeat serum theophylline levels in patients with sustained-release theophylline overdose. Gastric pharmacobezoar formation should be considered in cases of sustained-release theophylline overdose with rising theophylline levels and patient deterioration, despite adequate gut decontamination.
authors.affiliation: Department of Emergency Medicine, State University of New York, Buffalo.
authors.forename: G
authors.initials: G
authors.lastname: Bernstein
authors.forename: D
authors.initials: D
authors.lastname: Jehle
authors.forename: E
authors.initials: E
authors.lastname: Bernaski
authors.forename: G R
authors.initials: GR
authors.lastname: Braen
mesh_terms: D001630:Bezoars / Q000150:complications*; D002606:Charcoal / Q000008:administration & dosage / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000506:poisoning*; D008875:Middle Aged; D013270:Stomach; D013806:Theophylline / Q000506:poisoning*
chemical_list: D003692:Delayed-Action Preparations; D002606:Charcoal; D013806:Theophylline; D007052:Ibuprofen