Theophylline toxicity: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Theophylline level | *Theophylline level<ref name="Aggelopoulou">Aggelopoulou, E., Tzortzis, S., Tsiourantani, F., Agrios, I., & Lazaridis, K. (2018). Atrial Fibrillation and Shock: Unmasking Theophylline Toxicity. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 27(4), 387-391.</ref> | ||
**10–20 μg/mL - Therapeutic | |||
**20-80 μg/mL - Toxic level | |||
**80-100 μg/mL - Severe toxicity or death | |||
*[[ECG]] | *[[ECG]] | ||
*Metabolic panel | *Metabolic panel | ||
*Lactic acid level | *Lactic acid level | ||
*CK | *CK | ||
*Evaluate for co-ingestion | |||
==Management== | ==Management== | ||
*Supportive care is the mainstay of treatment | *Supportive care is the mainstay of treatment | ||
*Cardiovascular | *Cardiovascular | ||
** | **Norepinephrine (alpha-agonist) for hypotension resistant to IVF | ||
**Refractory hypotension may respond to non-selective beta-blockers<ref name="Fisher" /> | **Refractory hypotension may respond to non-selective beta-blockers<ref name="Fisher" /> | ||
**Beta-blockers (esmolol preferred due to short half-life) for tachydysrhythmias | |||
*GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]]) | *GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]]) | ||
**Consider in recent severe overdose | **Consider in recent severe overdose | ||
| Line 52: | Line 57: | ||
**Phenobarbital if [[lorazepam]] ineffective | **Phenobarbital if [[lorazepam]] ineffective | ||
**Phenytoin (Dilantin) contraindicated as increases seizure in animal studies | **Phenytoin (Dilantin) contraindicated as increases seizure in animal studies | ||
*Dialysis | *Dialysis or plasmapheresis | ||
**Indicated in [[seizures]], severe [[arrhythmias]] | **Indicated in [[seizures]], severe [[arrhythmias]], hypotension, serum level >90 μg/mL (>40 μg/mL in chronic ingestion) | ||
==Disposition== | ==Disposition== | ||
*Almost all patients will require admission | |||
* | *Can consider discharge with close followup (in conjunction with toxicology) if unintentional overdose, asymptomatic, and normal vital signs | ||
==See Also== | ==See Also== | ||
Latest revision as of 23:51, 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 (due to β2-mediated vasodilation)
- Metabolic
- Neurologic
- Tremor
- Agitation
- Seizure
- GI
Differential Diagnosis
Evaluation
- Theophylline level[2]
- 10–20 μg/mL - Therapeutic
- 20-80 μg/mL - Toxic level
- 80-100 μg/mL - Severe toxicity or death
- ECG
- Metabolic panel
- Lactic acid level
- CK
- Evaluate for co-ingestion
Management
- Supportive care is the mainstay of treatment
- Cardiovascular
- Norepinephrine (alpha-agonist) for hypotension resistant to IVF
- Refractory hypotension may respond to non-selective beta-blockers[1]
- Beta-blockers (esmolol preferred due to short half-life) for tachydysrhythmias
- GI decontamination (Multidose Activated Charcoal, Whole Bowel Irrigation)
- Consider in recent severe overdose
- Contraindications: unsecured airway, nausea/vomiting, ileus, Bowel Obstruction, or need for emergent endoscopy
- Seizures
- Dialysis or plasmapheresis
- Indicated in seizures, severe arrhythmias, hypotension, serum level >90 μg/mL (>40 μg/mL in chronic ingestion)
Disposition
- Almost all patients will require admission
- Can consider discharge with close followup (in conjunction with toxicology) if unintentional overdose, asymptomatic, and normal vital signs
See Also
External Links
References
- ↑ 1.0 1.1 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.
- ↑ Aggelopoulou, E., Tzortzis, S., Tsiourantani, F., Agrios, I., & Lazaridis, K. (2018). Atrial Fibrillation and Shock: Unmasking Theophylline Toxicity. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 27(4), 387-391.