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Pediatric Theophylline Toxicity Medication

  • Author: Tracey H Reilly, MD; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Jun 08, 2016
 

Antiemetics

Class Summary

These agents may be used to control vomiting. Phenothiazine antiemetics should be avoided to prevent potentiation of theophylline toxicity.

Metoclopramide (Reglan)

 

Dopamine antagonist that stimulates acetylcholine release in myenteric plexus. Centrally acts on chemoreceptor triggers in floor of fourth ventricle, which provides important antiemetic activity.

Ondansetron (Zofran)

 

Selective 5-HT3-receptor antagonist that blocks serotonin peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin) and complete-body radiation therapy.

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Drug absorption reducers

Class Summary

Activated charcoal is used to decrease drug absorption and may be all that is required in mild-to-moderate toxicity. It is not absorbed and is excreted entirely through the GI tract.

Activated charcoal (Actidose-Aqua, Liqui-Char)

 

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal absorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water. For maximum effect, administer within 30 min after poison ingestion.

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Whole bowel irrigation agents

Class Summary

Polyethylene glycol is used to increase GI transit time, decreasing absorption of theophylline. It may be used in older children or adults who have ingested significant amounts of products with delayed absorption. It is not absorbed and is entirely excreted through the GI tract.

Polyethylene glycol (GoLYTELY, NuLytely, Colovage, Colyte)

 

Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.

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Benzodiazepines

Class Summary

These agents may be needed to control agitation and seizures.

Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic system, reticular formation), possibly by increasing activity of GABA. Individualize dose and increase doses cautiously to avoid adverse effects.

Lorazepam (Ativan)

 

Sedative hypnotic with short onset of effects and relatively long half-life. May depress all levels of CNS, including limbic system and reticular formation, by increasing action of GABA, a major inhibitory neurotransmitter in the brain. Excellent when sedation longer than 24 hours is needed.

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Alpha agonists

Class Summary

These agents are used to treat hypotension refractory to fluid challenge.

Phenylephrine (Neo-Synephrine)

 

Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. Increases peripheral venous return.

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Beta-adrenergic blocking agents

Class Summary

These agents are used to treat severe tachycardia with ischemia or severe hypertension. Short-acting agents should be used because of the potential for significant hypotension in theophylline toxicity.

Esmolol (Brevibloc)

 

Excellent in patients at risk for complications from beta-blockade, particularly those with reactive airway disease, mild-to-moderate LV dysfunction, and/or peripheral vascular disease. Short half-life of 8 min allows for titration to desired effect and quick discontinuation if needed.

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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, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher P Holstege, MD Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center

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

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

Specialty Editor Board

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: Received salary from Merck for employment.

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, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

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

Disclosure: Nothing to disclose.

References
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  4. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). 2007 Dec. 45(8):815-917. [Medline].

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  6. Hopkins ME, MacKenzie-Ross RV. Case Report: The risks associated with chronic theophylline therapy and measures designed to improve monitoring and management. BMC Pharmacol Toxicol. 2016 Mar 5. 17:13. [Medline].

  7. Novelli G, Rossi M, Morabito V, et al. Pediatric acute liver failure with molecular adsorbent recirculating system treatment. Transplant Proc. 2008 Jul-Aug. 40(6):1921-4. [Medline].

  8. Fisher J, Graudins A. Intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for acute theophylline toxicity. J Med Toxicol. 2015 Sep. 11 (3):359-63. [Medline].

  9. Charytan D, Jansen K. Severe metabolic complications from theophylline intoxication. Nephrology (Carlton). 2003 Oct. 8(5):239-242. [Medline].

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

 
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