Ketosis, a complication of theophylline toxicity

A case of prolonged theophylline toxicity in a young non-diabetic female is reported. Blood gas analysis revealed a mixed respiratory alkalosis and metabolic acidosis. The metabolic acidosis was due to ketoacids, which were detected in the patient's breath and urine. The ketones cleared rapidly when theophylline elimination was increased with activated charcoal, i.v. metoprolol reduced excessive b-adrenergic stimulation and a 10% dextrose infusion repleted hepatic glycogen. Theophylline is known to increase free fatty acid levels. It is postulated that prolonged fasting led to depletion of hepatic glycogen and that ketones were generated by metabolism of elevated serum fatty acids. In previous reviews of the metabolic abnormalities associated with theophylline toxicity ketosis has not been described.