The Old Friend Ruthless Enemy - Theophylline Toxicity: A Case Report

Abstract

Theophylline is an old drug of modern medicine. Theophylline toxicity may develop both with acute or chronic intakes due to its narrow therapeutic index. We present a case of theophylline toxicity because of its severe and lethal cardiac and metabolic toxic effects and good response to extracorporeal and medical therapies. A 15-year-old girl with a history of multiple drug intake was admitted to our pediatric intensive care unit due to paracetamol overdose. Theophylline poisoning was suspected because of clinical signs of tachycardia, tachypnea, agitation and metabolic signs of hyperglycemia, hypophosphatemia, hypokalemia,and hypomagnesemia in the early course of hospitalization and blood sample was taken for the measurement of theophylline blood level. The patient was considered as having theophylline toxicity due to high theophylline blood level (112 μg/mL) and normal paracetamol blood level. The patient was intubated because of clinical deterioration, and midazolam for sedation and fentanyl for analgesia were started. Ventricular extrasystoles were detected and after a bolus injection, lidocain infusion was started. Dexmedetomidine and esmolol for tachycardia and levetiracetam for seizure prophylaxis and electrolyte replacement for metabolic disturbances were started as medical treatments. Continuous venovenous hemodialysis was administered for three days and therapeutic plasma exchange was performed for three times with 4% albumin solution (1.5 plasma volume in the first session) and fresh frozen plasma solutions (second and third sessions with one plasma volume). The patient was extubated on the third day and medical therapies were terminated on the fourth day of hospitalization. The patient was discharged on fifth day of hospitalization to the pediatric ward.

Keywords

• theophylline
• poisoning
• dexmedetomidine
• hemodialysis
• plasma exchange