A 67-yr -old man with known long-standing asthma presents to the ER following an overdose of his regular theophylline. He took 20 tablets of theophylline 1 hour earlier because he is feeling rather depressed.
Which of the following is true concerning theophylline overdoses?
A. Symptoms of toxicity will always occur within 12 hours
B. Nausea and vomiting are uncommon features of toxicity
C. Bradycardia is the commonest cardiac arrhythmia
D. Large doses of IV potassium should be given as soon as possible
E. Multi-dose activated charcoal is useful in management
Answer:
E--Multi-dose activated charcoal is useful in management
Discussion: Features of theophylline toxicity include tachyarrhythmias, nausea, vomiting, diarrhea,
central nervous system stimulation and, less commonly, metabolic effects including hypokalaemia and hyperglycaemia. Symptoms of toxicity may be delayed following the ingestion of sustained-release preparations for up to 48 hours.
Management of a theophylline overdose in patients who have ingested large quantities of sustained-release tablets includes whole bowel irrigation and multi-dose activated charcoal, which increases removal from the enterohepatic circulation. Charcoal haemoperfusion is more efficient at enhanced elimination of theophylline than haemoperfusion or haemodialysis. Hypokalaemia may correct rapidly, frequent monitoring of potassium levels is therefore very important, to avoid rebound
hypokalaemia, at this stage, (only 1 hr after overdose), large doses are almost certainly not required.
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