Theophylline toxicity: Difference between revisions
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#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 | ###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 | ||
#Cardiovascular | #Cardiovascular | ||
##[[IV Fluids]] for [[hypotension]] | ##[[IV Fluids]] for [[hypotension]] | ||
Line 48: | Line 48: | ||
#Supportive care | #Supportive care | ||
##Cardiac monitoring | ##Cardiac monitoring | ||
##Zofran for antiemetic | ##Ondansterone (Zofran) for antiemetic | ||
##EEG for sedated and paralyzed patients | ##EEG for sedated and paralyzed patients | ||
Revision as of 22:27, 9 June 2014
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
Workup
- EKG
- 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
- Ondansterone (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
Sources
Tintinalli