Reactions 1704, p358 - 2 Jun 2018 Theophylline toxicity: case report A 4-year-old girl developed vomiting, diarrhoea, decreased response, focal seizures, hypokalaemia, hyperglycaemia, respiratory acidosis, metabolic acidosis, sinus tachycardia and respiratory failure following exploratory ingestion of theophylline [amount of drug ingested not stated]. The girl presented to the emergency department for vomiting and diarrhoea, persisting for several hours. She was diagnosed with urinary tract infection and was discharged on cotrimoxazole [trimethoprim/sulfamethoxazole] and treatment. She returned to the emergency department again and was found to be unresponsive, with a heart rate of 170 bpm, blood pressure of 82/46mm Hg and a respiratory rate of 40 breaths/minute. She also developed seizures. She was afebrile, however, laboratory tests were consistent with hypokalaemia, elevated creatinine, hyperglycaemia, metabolic acidosis and respiratory acidosis. Tests for the presence of various medications and drug abuse were absent. Her ECG revealed sinus tachycardia with QRS widening and QTc prolongation. A head CT did not show any abnormalities. Subsequently, her sibling revealed that the previous morning, she had ingested her father’s 200mg sustained-release theophylline tablets. Her theophylline level was ordered, which was significantly elevated. Her clinical condition declined and she was intubated due to respiratory failure. The girl started receiving treatment with rocuronium bromide [rocuronium] and etomidate. Additionally, activated charcoal was also administered, along with lorazepam, sodium chloride [saline] and potassium. She was transferred to the ICU and developed tachycardia and additional seizures en- route. She was treated with lorazepam, levetiracetam and sodium chloride. Her seizures subsequently resolved. Upon ICU admission, her heart rate was 176 bpm, blood pressure was 94/40mm Hg, body temperature was 98.9°F and respiratory rate was 48 breaths/minute. Her lungs were clear to auscultation and the abdomen was soft and non-distended. Clonus, focal deficits or hyperreflexia were absent. Laboratory tests showed that her theophylline level was still elevated. An ECG was consistent with sinus tachycardia with QRS widening and QTc prolongation. She was started on continuous renal replacement therapy (CRRT), and her theophylline levels declined over the next 30 hours. The CRRT was discontinued and she did not experience additional dysrhythmias or seizures. Her neurological status also improved. The day after admission, she was extubated and discharged without sequelae. Author comment: "A sibling then mentioned that the patient ingested their father’s 200 mg sustained-release theophylline tablets the previous morning." "We managed a case of severe theophylline toxicity in a 4-year old with an exploratory ingestion." Greene SC, et al. Theophylline toxicity: An old poisoning for a new generation of physicians. Turkish Journal of Emergency Medicine 18: 37-39, No. 1, Mar 2018. Available from: URL: http://doi.org/10.1016/j.tjem.2017.12.006 - USA 803322943 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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