Management of theophylline overdose patients in the intensive care unit.
In a retrospective survey of all adults admitted to the Intensive Care Unit with acute theophylline poisoning over the last five years, we identified 38 patients (6.8% of all admissions for poisoning), two of whom died. Thirty-five (92%) had taken a sustained-release preparation. Eight patients had grand mal seizures and six developed arrhythmias (ventricular fibrillation, 3; atrial fibrillation, 2; supraventricular tachycardia, 1). Severe vomiting was present in 34 (89%) and proved to be a serious obstacle to the administration of enteral charcoal. The vomiting was controlled by intravenous metoclopramide in seventeen patients (50%), but the remaining seventeen required mechanical ventilation with sedation and muscle relaxation for the effective delivery of nasogastric charcoal. Importantly, in nine (24%), the serum theophylline concentration continued to rise despite enteral charcoal. Charcoal haemoperfusion was used in seven (18%). We present an algorithm for the management of severe, acute theophylline poisoning.
Henderson
A
A
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Wright
D M
DM
Pond
S M
SM
D000042:Absorption; D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002606:Charcoal / Q000627:therapeutic use; D003422:Critical Care; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D005751:Gastric Lavage; D006464:Hemoperfusion; D006801:Humans; D007902:Length of Stay; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced; D015996:Survival Rate; D013806:Theophylline / Q000097:blood / Q000506:poisoning*; D014839:Vomiting / Q000150:complications / Q000517:prevention & control
D002606:Charcoal; D013806:Theophylline; D008787:Metoclopramide; D011188:Potassium