Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication.
OBJECTIVE
To determine the comparative efficacy of hemoperfusion and hemodialysis for severe theophylline toxicity in concurrent case series.


METHODS
A 10-year, prospective, observational study was performed of consecutive patients referred to a regional poison control center with severe theophylline intoxication in whom either hemodialysis or hemoperfusion was used. The primary outcomes were 1) incidence of major theophylline toxicity (convulsions or life-threatening cardiac dysrhythmias) during or after each procedure, 2) calculated theophylline clearance, and 3) procedure-related complications.


RESULTS
Over the study period, 56 patients underwent hemodialysis or hemoperfusion as treatment of severe theophylline intoxication. Overall mean age was 40.5 +/- 22.9 years. Mean peak serum theophylline concentration was 103.3 +/- 39.1 micrograms/mL (range 36 to 245 micrograms/mL). Thirty patients (54%) were victims of acute theophylline intoxication, while 18 (32%) had chronic overmedication and 8 (14%) had acute-on-therapeutic intoxication. Thirty-nine patients (70%) underwent hemodialysis, while 17 (30%) underwent hemoperfusion. There were no significant intergroup differences in age (39.4 vs 43.0 yr), peak serum theophylline concentration (99.5 vs 112.1 micrograms/mL), time to procedure (8.4 vs 6.3 hr), or duration of procedure (4.1 vs 3.7 hr). Thirty-three percent of the patients undergoing hemodialysis had major toxicity during or after the procedure, compared with 18% of those who received hemoperfusion (p = NS). Post-procedure serum theophylline concentrations were 26.9 vs 30.4 micrograms/mL, corresponding to drug clearance rates of 185.1 and 294.8 mL/kg/hr (p = 0.03). Procedural complications occurred in 3 patients who received hemoperfusion and consisted of bleeding diatheses and hypocalcemia. No complications occurred in patients receiving hemodialysis (p = 0.007).


CONCLUSIONS
These data confirm that hemoperfusion provides a higher theophylline clearance rate than hemodialysis. However, hemodialysis appears to have comparable efficacy in reducing the morbidity of severe theophylline intoxication and is associated with a lower rate of procedural complications.
Shannon
M W
MW
Children's Hospital, Department of Pediatrics, Boston, MA 02115. shannon@al.tch.harvard.edu
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000506:poisoning*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D062787:Drug Overdose; D005260:Female; D006464:Hemoperfusion / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011041:Poisoning / Q000145:classification / Q000628:therapy; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012306:Risk; D013806:Theophylline / Q000506:poisoning*; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D013806:Theophylline