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 | #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 | ||
##Tachycardia | ##[[Sinus Tachycardia]] | ||
##Atrial/Ventricular arrhythmias | ##Atrial/Ventricular [[arrhythmias]] | ||
##Hypotension | ##[[Hypotension]] | ||
#Metabolic | #Metabolic | ||
##Hypokalemia | ##[[Hypokalemia]] | ||
##Metabolic | ##[[Metabolic Acidosis]] | ||
##Hyperthermia | ##[[Hyperthermia]] | ||
##Rhabdomyolysis | ##[[Rhabdomyolysis]] | ||
##Hyperglycemia | ##[[Hyperglycemia]] | ||
#GI | #GI | ||
##Nausea/Vomiting | ##[[Nausea/Vomiting]] | ||
==Workup== | ==Workup== | ||
#EKG | #[[EKG]] | ||
#Chem | #Chem | ||
#CK | #CK | ||
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==Management== | ==Management== | ||
#GI decontamination (Multidose | #GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]]) | ||
##Considered in life-threatening overdose | ##Considered in life-threatening overdose | ||
###contraindications: unsecured airway, nausea, vomiting, ileus, | ###contraindications: unsecured airway, nausea, vomiting, [[ileus]], [[Bowel Obstruction]], or need for emergent endoscopy | ||
#Seizures | #[[Seizures]] | ||
##Ativan 1st line | ##[[Ativan]] 1st line | ||
##Phenobarbital if Ativan ineffective | ##Phenobarbital if Ativan ineffective | ||
##Dilatin contraindicated as increases seizure in animal studies | ##[[Dilatin]] contraindicated as increases seizure in animal studies | ||
#Cardiovascular | #Cardiovascular | ||
##IV | ##[[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 | ||
Revision as of 22:14, 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
- 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