Pediatric Theophylline Toxicity Follow-up

  • Author: Tracey H Reilly, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Nov 21, 2011
 

Further Inpatient Care

  • Admit all patients with signs or symptoms of theophylline toxicity.
  • Admit patients with serial unchanged or increasing theophylline levels of more than 30 mcg/mL in acute or acute-on-chronic ingestions of sustained-release preparations.
  • Admit patients with cardiovascular or neurologic symptoms to the ICU, with airway management, monitoring, and supportive care as indicated.
  • Patients with significant cardiovascular or neurologic symptoms should receive hemodialysis. Multidose activated charcoal should be used for patients with less severe toxicity.
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Further Outpatient Care

  • Patients with 2 consecutive decreasing theophylline levels of less than 30 mcg/mL, determined at least 2 hours apart, who are asymptomatic and who have no comorbid conditions may be considered for discharge.
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Inpatient & Outpatient Medications

  • Inpatient medications have been discussed previously (see Medication).
  • Patients with 2 consecutive decreasing levels of less than 30 mcg/mL who are asymptomatic may be discharged, and further doses of theophylline should not be resumed until levels are within the therapeutic range (10-20 mcg/mL).
  • No outpatient medications are required for the treatment of theophylline toxicity.
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Transfer

  • Patients with dysrhythmias, hemodynamic instability, or severe agitation, altered mental status, or seizures after ingestions of significant amounts of theophylline should be transferred to the ICU. These patients should also be transferred to facilities that can provide hemodialysis.
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Deterrence/Prevention

  • Drug levels should be periodically monitored in patients who are being treated with theophylline.
  • Particular attention should be paid to potential drug interactions.
  • Macrolide and quinolone antibiotics should be avoided. If they are administered, theophylline levels should be carefully monitored.
  • Patients should be counseled about the potential for serious toxicity in acute and chronic overdose and about the potential for drug interactions.
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Prognosis

  • The prognosis of patients with theophylline toxicity depends on the amount and severity of the ingestion. Significant ingestions increase the risk of death from dysrhythmias, refractory hypotension, or status epilepticus.
  • Hypoxic brain injury is a risk in patients with status epilepticus, prolonged hypotension, or significant aspiration causing hypoxia.
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Patient Education

  • Patients should be advised of the potential for serious toxicity in acute and chronic overdose and of the potential for serious drug interactions.
  • Patients should be advised that current drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD), such as inhaled beta-agonists and inhaled steroids, offer better therapeutic effects without the risk of significant toxicity associated with theophylline.
  • For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.
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Contributor Information and Disclosures
Author

Tracey H Reilly, MD  Attending Physician, Department of Emergency Medicine, United Health Services Hospitals

Tracey H Reilly, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher P Holstege, MD  Associate Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Director, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center; Associate Medical Toxicology Fellowship Director, Veterans Affairs Department of Health

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, European Association of Poisons Centres and Clinical Toxicologists, Medical Society of Virginia, Society for Academic Emergency Medicine, Society of Toxicology, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Chandra D Aubin, MD  Associate Residency Director, Division of Emergency Medicine, Assistant Professor, Washington University School of Medicine

Disclosure: Nothing to disclose.

Michael E Mullins, MD  Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Specialty Editor Board

Halim Hennes, MD, MS  Division Director, Pediatric Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Director of Emergency Services, Children's Medical Center

Halim Hennes, MD, MS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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  9. Minton NA, Henry JA. Acute and chronic human toxicity of theophylline. Hum Exp Toxicol. Jun 1996;15(6):471-81. [Medline].

  10. Minton NA, Henry JA. Treatment of theophylline overdose. Am J Emerg Med. Oct 1996;14(6):606-12. [Medline].

  11. Rutten J, van den Berg B, van Gelder T, van Saase J. Severe theophylline intoxication: a delay in charcoal haemoperfusion solved by oral activated charcoal. Nephrol Dial Transplant. Dec 2005;20(12):2868-9. [Medline].

  12. Shannon MW. Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication. Acad Emerg Med. Jul 1997;4(7):674-8. [Medline].

  13. Stork CM, Howland MA, Goldfrank LR. Concepts and controversies of bronchodilator overdose. Emerg Med Clin North Am. May 1994;12(2):415-36. [Medline].

  14. Watson WA, Litovitz TL, Rodgers GC, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline].

 
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