SAQ 166 – Toxicology – theophylline toxicity

Question 9. theophylline toxicity.

a. Early clinical features

• Vomiting.
• Tremor.
• Tachycardia.

b. Investigations

• Serial theophylline levels.
• ECG.
• Venous or arterial blood gas.
• Also assess glucose, potassium, and magnesium.

c. Decontamination

• Give activated charcoal 1 g/kg, to a maximum of 50 g, orally or by nasogastric tube.
• Charcoal may remain indicated even after delayed presentation.
• Protect the airway and manage vomiting aggressively; intubation may be required.

d. Enhanced elimination

• Haemodialysis is the definitive life-saving enhanced-elimination treatment and is most effective when started early.
• Commence when life-threatening toxicity is anticipated from levels or manifestations such as arrhythmia, hypotension, or seizures.
• Multiple-dose activated charcoal is indicated in severe toxicity but must not delay haemodialysis.

e. Severe toxicity and treatment