Theophylline Poisoning

Description

General measures

Medicine treatment

Referral

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T48.6 + (X44.99/X64.99/Y14.99)

DESCRIPTION

Patients present with:

• tachycardia and tachyarrhythmias,
• hyperventilation
• nausea and vomiting
• tremor
• agitation
• profound hypokalaemia
• seizures

GENERAL MEASURES

• Monitor ECG and treat dysrhythmias.
• Monitor and correct fluid status and electrolyte abnormalities.
• Monitor theophylline concentrations, if available. Levels may continue to rise up to 24 hours after ingestion of modified release preparations.

MEDICINE TREATMENT

• Activated charcoal, oral, 50 g diluted in 100 mL water.
  • Multiple doses of activated charcoal enhance elimination.

LoE:IIIa^xli

Vomiting is common: (R11)

• Metoclopramide, IV/oral, 10 mg 8 hourly as required.

LoE:IVb

Correct hypokalaemia cautiously: E87.6 + (T48.6+X44.99/X64.99/Y14.99)

• Potassium chloride, IV, 20 to 40 mmol/L in sodium chloride, 0.9%
  • Maximum rate of infusion: 20 mmol/hour.

LoE:IIIa^xlii

For seizures: R56.8 + (T48.6+X44.99/X64.99/Y14.99)

Treat with benzodiazepines - see: Status epilepticus.

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Note:
Phenytoin should be avoided (due to potential cardiotoxicity).

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LoE:IVb^xliii

REFERRAL

In patients with symptoms of severe overdose (severe hypokalaemia, seizures, refractory hypotension, dysrhythmias, theophylline level >555 μmol/L (100 mg/L), refer for haemodialysis.

LoE:IIIa^xliv 

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.0_27 March 2025

Chapter 19 Poisoning_19.8 Theophylline Poisoning