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Theophylline Toxicity Clinical Presentation

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

History

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.

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Physical

Cardiovascular

See the list below:

Pulmonary

See the list below:

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

Neurological

See the list below:

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

Gastrointestinal

See the list below:

  • Nausea
  • Vomiting
  • Abdominal cramps
  • Diarrhea
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Causes

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
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Contributor Information and Disclosures
Author

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.

References
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  2. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015 Dec. 53 (10):962-1147. [Medline]. [Full Text].

  3. 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].

  4. Hocaoğlu N, Yıldıztepe E, Bayram B, Aydın B, Tunçok Y, Kalkan Ş. Demographic and Clinical Characteristics of Theophylline Exposures between 1993 and 2011. Balkan Med J. 2014 Dec. 31 (4):322-7. [Medline].

  5. Seneff M, Scott J, Friedman B, Smith M. Acute theophylline toxicity and the use of esmolol to reverse cardiovascular instability. Ann Emerg Med. 1990 Jun. 19(6):671-3. [Medline].

  6. Kearney TE, Manoguerra AS, Curtis GP, Ziegler MG. Theophylline toxicity and the beta-adrenergic system. Ann Intern Med. 1985 Jun. 102(6):766-9. [Medline].

  7. Brashear RE, Aronoff GR, Brier RA. Activated charcoal in theophylline intoxication. J Lab Clin Med. 1985 Sep. 106(3):242-5. [Medline].

  8. Charytan D, Jansen K. Severe metabolic complications from theophylline intoxication. Nephrology (Carlton). 2003 Oct. 8(5):239-42. [Medline].

  9. Cooling DS. Theophylline toxicity. J Emerg Med. 1993 Jul-Aug. 11(4):415-25. [Medline].

  10. Gaudreault P, Harwood-Nuss. Methylxanthines, Toxicology. Clinical Practice of Emergency Medicine. 4th ed. 2005. 1649-1652.

  11. Henderson A, Wright DM, Pond SM. Management of theophylline overdose patients in the intensive care unit. Anaesth Intensive Care. 1992 Feb. 20(1):56-62. [Medline].

  12. Kallstrom TJ. Evidence-based asthma management. Respir Care. 2004 Jul. 49(7):783-92. [Medline].

  13. Marshall H, Emerman CL, Tintinalli J. Theophylline, Toxicology and Pharmacology. Emergency Medicine, A Comprehensive Study Guide. 6th ed. 2004. 1098-1101.

  14. Medical Economics Staff. Drugs. Physician's Desk Reference. Medical Economics Co; 1997.

  15. Micromedex. Theophylline. Micromedex. 1974-2008. 36.

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