Theophylline toxicity: Difference between revisions

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==Background==
==Background==
#Still used in patients with debilitating brochospastic disease
*Still used in patients with debilitating brochospastic disease
#Studied for treatment of [[Acute Mountain Sickness]] and [[Contrast-Induced Nephropathy]]
*Studied for treatment of [[Acute Mountain Sickness]] and [[Contrast-Induced Nephropathy]]
#PO in elixir, extended release, or controlled release forms but absorption erratic
*PO in elixir, extended release, or controlled release forms but absorption erratic
#IV as aminophylline
*IV as aminophylline
#Adenosine antagonism, Increase catecholamines, and Phosphodiesterase inhibition
*Adenosine antagonism, Increase catecholamines, and Phosphodiesterase inhibition


==Clinical Features==
==Clinical Features==
#Neurologic
*Neurologic
##Tremor
**Tremor
##Agitation
**Agitation
##[[Seizure]]
**[[Seizure]]
#Cardiovascular
*Cardiovascular
##[[Sinus Tachycardia]]
**[[Sinus Tachycardia]]
##Atrial/Ventricular [[arrhythmias]]
**Atrial/Ventricular [[arrhythmias]]
##[[Hypotension]]
**[[Hypotension]]
#Metabolic
*Metabolic
##[[Hypokalemia]]
**[[Hypokalemia]]
##[[Metabolic Acidosis]]
**[[Metabolic Acidosis]]
##[[Hyperthermia]]
**[[Hyperthermia]]
##[[Rhabdomyolysis]]
**[[Rhabdomyolysis]]
##[[Hyperglycemia]]
**[[Hyperglycemia]]
#GI
*GI
##[[Nausea/Vomiting]]
**[[Nausea/Vomiting]]


==Workup==
==Workup==
#[[ECG]]
*[[ECG]]
#Chem
*Chem
#CK
*CK
#Theophylline level
*Theophylline level


==Management==
==Management==
#GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]])
*GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]])
##Considered in life-threatening overdose
**Considered in life-threatening overdose
###contraindications: unsecured airway, [[nausea]], [[vomiting]], ileus, [[Bowel Obstruction]], or need for emergent endoscopy
***contraindications: unsecured airway, [[nausea]], [[vomiting]], ileus, [[Bowel Obstruction]], or need for emergent endoscopy
#[[Seizures]]
*[[Seizures]]
##[[Lorazepam]] (Ativan) 1st line
**[[Lorazepam]] (Ativan) 1st line
##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
#Cardiovascular
*Cardiovascular
##[[IV Fluids]] for [[hypotension]]
**[[IV Fluids]] for [[hypotension]]
##Beta blockers for [[tachyarrhymias]]
**Beta blockers for [[tachyarrhymias]]
###Controversial, involve a toxicologist
***Controversial, involve a toxicologist
#Dialysis
*Dialysis
##Indicated in [[seizures]], severe [[arrhythmias]]
**Indicated in [[seizures]], severe [[arrhythmias]]
##Theophylline level >90mcg/ml in acute ingestion
**Theophylline level >90mcg/ml in acute ingestion
##Theophylline level >40mcg/ml in chronic ingestion
**Theophylline level >40mcg/ml in chronic ingestion
#Supportive care
*Supportive care
##Cardiac monitoring
**Cardiac monitoring
##Ondansetron (Zofran) for antiemetic
**Ondansetron (Zofran) for antiemetic
##EEG for sedated and paralyzed patients
**EEG for sedated and paralyzed patients


==Disposition==
==Disposition==
#Immediate release
*Immediate release
##Home after 6 hours if  
**Home after 6 hours if  
###nontoxic
***nontoxic
###asymptomatic
***asymptomatic
###and, normal vital sign
***and, normal vital sign
#Sustained release
*Sustained release
##Home after 12 hours if
**Home after 12 hours if
###nontoxic
***nontoxic
###asymptomatic
***asymptomatic
###and, normal vital sign
***and, normal vital sign


==References==
==References==


[[Category:Toxicology]]
[[Category:Toxicology]]

Revision as of 22:14, 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

Workup

  • ECG
  • Chem
  • CK
  • Theophylline level

Management

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

References