Theophylline Toxicity in Emergency Medicine Workup

  • Author: Greg Hymel, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jul 12, 2011
 

Laboratory Studies

Obtain serum theophylline level upon presentation and then every 2 hours until the level falls. This is especially important following ingestion of extended-release formulations. Theophylline can form bezoars, resulting in ongoing absorption and toxicity despite general measures at GI decontamination.

WBC can be elevated (due to increased catecholamine activity).

Obtain acetaminophen (paracetamol) level.

Obtain aspirin (ASA) level, particularly in patients with history and findings suggestive of aspirin toxicity, including but not limited to metabolic acidosis, respiratory alkalosis, and change of mental status.

Order electrolytes and glucose tests to evaluate for the following:

  • Hypokalemia (serial testing of serum potassium levels may be required)
  • Hyperglycemia
  • Metabolic acidosis (lactate)
  • Hypocalcemia/hypercalcemia
  • Hypophosphatemia
  • Ketosis

Test for pregnancy in women of childbearing age.

Next

Imaging Studies

  • Obtain a CT scan of the brain if seizures occur.
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Other Tests

  • Electrocardiogram, looking for evidence of electrolyte abnormalities and dysrhythmias. Also, ECG should be used to evaluate for the signs of TCAs or other cardioactive drug toxicity.
  • Lumbar puncture may be required for the evaluation of new-onset seizures.
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Contributor Information and Disclosures
Author

Greg Hymel, MD  Assistant Medical Director, Department of Emergency Medicine, Mercy Saint Vincent Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 and American College of Physician Executives

Disclosure: Nothing to disclose.

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  Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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.

References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-11178. [Full Text].

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

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

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

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

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

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

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

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

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

  11. Medical Economics Staff. Drugs. In: Physician's Desk Reference. Medical Economics Co; 1997.

  12. Micromedex. Theophylline. In: Micromedex. 1974-2008:36.

 
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