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Massive theophylline overdose with atypical metabolic abnormalities.

S H Eshleman1, L M Shaw

  • 1Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104.

Clinical Chemistry
|February 1, 1990
PubMed
Summary

A fatal theophylline overdose in a teen resulted in seizures and cardiac arrest. Unique metabolic abnormalities, including severe hyperkalemia and acidosis, were observed, likely due to extensive tissue damage.

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Area of Science:

  • Toxicology
  • Emergency Medicine
  • Pediatric Critical Care

Background:

  • Theophylline is a bronchodilator used for asthma management.
  • Theophylline overdose can lead to serious toxicity, including seizures and cardiac arrhythmias.
  • Fatal outcomes are rare but associated with extremely high serum concentrations.

Observation:

  • A 16-year-old asthmatic presented with seizures, respiratory arrest, and a serum theophylline level of 117 mg/L.
  • The patient developed refractory hypotension and widespread ischemic necrosis affecting skeletal muscle, bowel, and liver.
  • Early metabolic derangements included severe hyperkalemia, hyperphosphatemia, hypermagnesemia, hypocalcemia, and profound metabolic acidosis.

Findings:

  • The observed metabolic abnormalities differed from those typically seen in massive theophylline overdose.

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  • These unique metabolic changes were attributed to extensive ischemic tissue damage and subsequent release of intracellular ions.
  • Elevated serum creatine kinase, aspartate aminotransferase, and alanine aminotransferase activities indicated significant tissue injury.

    • Implications:

    • This case highlights the potential for severe and atypical metabolic complications in massive theophylline overdose.
    • Understanding these metabolic shifts is crucial for managing critically ill patients with theophylline toxicity.
    • The findings underscore the importance of aggressive supportive care and monitoring for widespread organ damage in such cases.