Theophylline toxicity: Difference between revisions
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''See [[theophylline]] for general drug information.'' | ''See [[theophylline]] for general drug information.'' | ||
==Background== | ==Background== | ||
* | *Primarily used as a bronchodilator, however rarely used now due to better available options | ||
* | *Also studied for treatment of [[Acute Mountain Sickness]] and [[Contrast-Induced Nephropathy]] | ||
*PO | *PO available as elixer and capsule (12 or 24-hour extended release) | ||
*IV as aminophylline | *IV as aminophylline (shorter acting than PO) | ||
* | *Mechanism of action<ref name="Fisher">Fisher, J., & Graudins, A. (2015). Intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for acute theophylline toxicity. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(3), 359-63.</ref>: | ||
**Release of endogenous catecholamines → β2 agonism → bronchodilation | |||
**PDE inhibition → increases cAMP | |||
**Adenosine antagonist | |||
==Clinical Features== | ==Clinical Features== | ||
*Cardiovascular | *Cardiovascular | ||
**[[Sinus Tachycardia]] | **[[Sinus Tachycardia]] | ||
**Atrial/Ventricular [[arrhythmias]] | **Atrial/Ventricular [[arrhythmias]] | ||
**[[Hypotension]] | **[[Hypotension]] (2/2 β2-mediated vasodilation) | ||
*Metabolic | *Metabolic | ||
**[[Hypokalemia]] | **[[Hypokalemia]] | ||
**[[Metabolic Acidosis]] | **[[Metabolic Acidosis]] | ||
**[[Hyperthermia]] | **[[Hyperthermia]] | ||
**[[Hyperglycemia]] | **[[Hyperglycemia]] | ||
*Neurologic | |||
**Tremor | |||
**Agitation | |||
**[[Seizure]] | |||
*GI | *GI | ||
**[[Nausea/Vomiting]] | **[[Nausea/Vomiting]] | ||
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==Evaluation== | ==Evaluation== | ||
*Theophylline level | |||
*[[ECG]] | *[[ECG]] | ||
* | *Metabolic panel | ||
*Lactic acid level | |||
*CK | *CK | ||
==Management== | ==Management== | ||
Revision as of 22:34, 15 November 2018
See theophylline for general drug information.
Background
- Primarily used as a bronchodilator, however rarely used now due to better available options
- Also studied for treatment of Acute Mountain Sickness and Contrast-Induced Nephropathy
- PO available as elixer and capsule (12 or 24-hour extended release)
- IV as aminophylline (shorter acting than PO)
- Mechanism of action[1]:
- Release of endogenous catecholamines → β2 agonism → bronchodilation
- PDE inhibition → increases cAMP
- Adenosine antagonist
Clinical Features
- Cardiovascular
- Sinus Tachycardia
- Atrial/Ventricular arrhythmias
- Hypotension (2/2 β2-mediated vasodilation)
- Metabolic
- Neurologic
- Tremor
- Agitation
- Seizure
- GI
Differential Diagnosis
Evaluation
- Theophylline level
- ECG
- Metabolic panel
- Lactic acid level
- CK
Management
- Supportive care
- Cardiac monitoring
- Ondansetron (Zofran) for antiemetic
- EEG for sedated and paralyzed patients
- Cardiovascular
- IV Fluids for hypotension
- Beta blockers for tachyarrhymias
- Esmolol particularly wise first-line agent
- Controversial, involve a toxicologist
- GI decontamination (Multidose Activated Charcoal, Whole Bowel Irrigation)
- Considered in life-threatening overdose
- contraindications: unsecured airway, nausea, vomiting, ileus, Bowel Obstruction, or need for emergent endoscopy
- Considered in life-threatening overdose
- Seizures
- Dialysis
- Indicated in seizures, severe arrhythmias
- Theophylline level >90mcg/ml in acute ingestion
- Theophylline level >40mcg/ml in chronic ingestion
Disposition
Immediate release
- Home after 6 hours if:
- nontoxic
- asymptomatic
- and, normal vital sign
Sustained release
- Home after 12 hours if:
- nontoxic
- asymptomatic
- and, normal vital sign
See Also
External Links
References
- ↑ Fisher, J., & Graudins, A. (2015). Intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for acute theophylline toxicity. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 11(3), 359-63.