Theophylline toxicity: Difference between revisions
| Line 55: | Line 55: | ||
==Disposition== | ==Disposition== | ||
===Immediate release=== | ===Immediate release=== | ||
*Home after 6 hours if | *Home after 6 hours if: | ||
**nontoxic | **nontoxic | ||
**asymptomatic | **asymptomatic | ||
| Line 61: | Line 61: | ||
===Sustained release=== | ===Sustained release=== | ||
*Home after 12 hours if | *Home after 12 hours if: | ||
**nontoxic | **nontoxic | ||
**asymptomatic | **asymptomatic | ||
Revision as of 22:15, 20 September 2016
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
- 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
- Cardiovascular
- IV Fluids for hypotension
- Beta blockers for tachyarrhymias
- Controversial, involve a toxicologist
- Dialysis
- Indicated in seizures, severe arrhythmias
- Theophylline level >90mcg/ml in acute ingestion
- Theophylline level >40mcg/ml in chronic ingestion
- Supportive care
- Cardiac monitoring
- Ondansetron (Zofran) for antiemetic
- EEG for sedated and paralyzed patients
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