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Severe lactic acidosis following theophylline overdose
1Department of Emergency Medicine, Dandenong and District Hospital, Victoria, Australia.
Annals of Emergency Medicine
|October 1, 1991
Summary
Theophylline overdose can cause severe lactic acidosis, even without hypoxemia or shock. Consider theophylline toxicity in unconscious patients with severe metabolic acidosis.
Area of Science:
- Toxicology
- Emergency Medicine
- Acid-Base Physiology
Background:
- Theophylline overdose commonly causes gastrointestinal, cardiovascular, neurologic, and electrolyte disturbances.
- Respiratory alkalosis is the typical acid-base finding, though mild metabolic acidosis can occur.
Observation:
- Two cases of severe lactic acidosis (pH 6.67 and 6.63) were observed in patients with theophylline overdose.
- These patients did not exhibit hypoxemia, shock, or prolonged seizures.
Findings:
- Severe lactic acidosis can be a presenting feature of theophylline toxicity.
- Theophylline toxicity may present with significant metabolic acidosis independent of other common complications.
Implications:
- Theophylline toxicity should be considered in emergency department presentations of unconscious patients with severe metabolic acidosis.
- This highlights the importance of considering toxicological etiologies in unexplained severe metabolic acidosis.
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