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Theophylline Toxicity Clinical Presentation

  • Author: Greg Hymel, MD; Chief Editor: Asim Tarabar, MD  more...
Updated: Jan 07, 2016


Symptomology correlates better with single acute ingestions than with chronic overexposures. Symptoms of acute theophylline overdose are as follows:

  • Nausea
  • Vomiting - Severe and protracted, acute overdose, chronic overdose, sustained-release preparations, immediate-release preparation
  • Abdominal pain
  • Mild metabolic acidosis
  • Hypokalemia
  • Hypophosphatemia
  • Hypocalcemia/hypercalcemia
  • Hyperglycemia
  • Tachycardia

Chronic theophylline overdose has minimal GI signs or symptoms.

Seizures, hypotension, and significant dysrhythmias usually are observed when serum levels approach 80 mcg/mL.

Seizures are more common with acute overdose than with chronic overdose. In chronic exposures, seizures may develop at lower serum concentrations (40-60 mcg/mL).

Cardiac dysrhythmias are more common following a chronic overdose rather than acute overdose and with lower serum concentrations.




See the list below:


See the list below:

  • Increased respiratory rate leads to respiratory alkalosis
  • Acute lung injury (ALI)
  • Respiratory failure leads to arrest


See the list below:

  • Tremors (most common)
  • Restlessness
  • Agitation
  • Hallucinations
  • Headaches
  • Irritability
  • Seizures (Persistent seizures may occur with serum levels >25 mcg/mL.)


See the list below:

  • Nausea
  • Vomiting
  • Abdominal cramps
  • Diarrhea


Chronic theophylline toxicity

See the list below:

  • Drug interactions (eg, ethanol [ETOH], cimetidine, oral contraceptives, allopurinol, macrolide, quinolone antibiotics)
  • Liver disease
  • Congestive heart failure
  • Febrile viral upper respiratory illness

Acute theophylline toxicity

See the list below:

  • Nonintentional overdose
  • Intentional overdose
Contributor Information and Disclosures

Greg Hymel, MD Assistant Medical Director, Associate Chairman, Department of Emergency Medicine, Mercy St Vincent Medical Center

Greg Hymel, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine, Excela Health System

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Lance W Kreplick, MD, FAAEM, MMM Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership

Disclosure: Nothing to disclose.

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