Theophylline toxicity: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Beta-2 agonist]] use | |||
*[[Sympathomimetic toxicity]] | |||
*[[Iron toxicity]] | |||
*[[Salicylate toxicity]] | |||
==Evaluation== | ==Evaluation== | ||
Revision as of 22:25, 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
- 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