Theophylline toxicity: Difference between revisions
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**[[Sinus Tachycardia]] | **[[Sinus Tachycardia]] | ||
**Atrial/Ventricular [[arrhythmias]] | **Atrial/Ventricular [[arrhythmias]] | ||
**[[Hypotension]] ( | **[[Hypotension]] (due to β2-mediated vasodilation) | ||
*Metabolic | *Metabolic | ||
**[[Hypokalemia]] | **[[Hypokalemia]] | ||
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==Management== | ==Management== | ||
*Supportive care | *Supportive care is the mainstay of treatment | ||
*Cardiovascular | *Cardiovascular | ||
** | **Consider norepinephrine (alpha-agonist) for hypotension | ||
** | **Refractory hypotension may respond to non-selective beta-blockers<ref name="Fisher" /> | ||
*GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]]) | *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]] | *[[Seizures]] | ||
**[[Lorazepam]] (Ativan) 1st line | **[[Lorazepam]] (Ativan) 1st line | ||
Revision as of 23:27, 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
- ECG
- Metabolic panel
- Lactic acid level
- CK
Management
- Supportive care is the mainstay of treatment
- Cardiovascular
- Consider norepinephrine (alpha-agonist) for hypotension
- Refractory hypotension may respond to non-selective beta-blockers[1]
- 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
- 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