Theophylline toxicity: Difference between revisions
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==Management== | ==Management== | ||
*GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]]) | #Supportive care | ||
#*Cardiac monitoring | |||
#*Ondansetron (Zofran) for antiemetic | |||
#*EEG for sedated and paralyzed patients | |||
#Cardiovascular | |||
#*[[IV Fluids]] for [[hypotension]] | |||
#*Beta blockers for [[tachyarrhymias]] | |||
#**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 | |||
#[[Seizures]] | |||
#*[[Lorazepam]] (Ativan) 1st line | |||
#*Phenobarbital if [[lorazepam]] ineffective | |||
#*Phenytoin (Dilantin) contraindicated as increases seizure in animal studies | |||
#Dialysis | |||
#*Indicated in [[seizures]], severe [[arrhythmias]] | |||
#*Theophylline level >90mcg/ml in acute ingestion | |||
#*Theophylline level >40mcg/ml in chronic ingestion | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:26, 20 September 2016
See theophylline for general drug information
Background
- Still used in patients with debilitating brochospastic disease
- Studied for treatment of Acute Mountain Sickness and Contrast-Induced Nephropathy
- PO in elixir, extended release, or controlled release forms but absorption erratic
- IV as aminophylline
- Adenosine antagonism, Increase catecholamines, and Phosphodiesterase inhibition
Clinical Features
- Neurologic
- Tremor
- Agitation
- Seizure
- Cardiovascular
- Sinus Tachycardia
- Atrial/Ventricular arrhythmias
- Hypotension
- Metabolic
- GI
Differential Diagnosis
Evaluation
- ECG
- Chem
- CK
- Theophylline level
Management
- Supportive care
- Cardiac monitoring
- Ondansetron (Zofran) for antiemetic
- EEG for sedated and paralyzed patients
- Cardiovascular
- IV Fluids for hypotension
- Beta blockers for tachyarrhymias
- 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