Massive Theophylline Overdose

Abstract

ANOREXIA, nausea, vomiting, irritability, hypotension, cardiac arrhythmias, and intractable fatal seizure activity are all well-known signs of toxic reactions to theophylline. In cases reported by Zwillich et al,¹seizure activity was associated with a mean theophylline level of 53 ±4.8 μg/mL (range, 25 to 70 μg/mL). Mortality after the onset of seizures is extremely high, ranging from 50%¹to 100%,²with substantial morbidity reported in survivors.³ The high mortality and morbidity associated with toxic theophylline levels, especially when associated with seizure activity, have prompted investigation into methods to improve removal of the drug from the body. A number of reports in the literature have described removal of the drug using hemoperfusion with charcoal.^3,4However, as Weinberger and Hendeles⁵have pointed out, rapid removal has not universally been associated with good outcome in the reported cases. We wish to report a case of massive theophylline