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[Status epilepticus in an asthmatic child]
P Casha1, O Bernard, M C Galland
1Service de pédiatrie, hôpital Nord, Marseille, France.
Insights
Chronic theophylline use for asthma poses risks, especially when combined with anti-histamines. A child experienced severe theophylline poisoning due to concurrent medication, highlighting potential drug interaction dangers.
Area of Science:
- Pharmacology
- Clinical Toxicology
- Pediatric Medicine
Background:
- Theophylline is a bronchodilator used for chronic asthma management.
- Concurrent prescription of other medications can pose risks to patients on theophylline therapy.
- Physician awareness of drug interactions is crucial for patient safety.
Observation:
- A pediatric patient with asthma on sustained-release theophylline was concurrently prescribed ketotifen and mequitazine (anti-H1 drugs).
- The patient presented with status epilepticus following vomiting.
- Elevated serum theophylline levels were detected, indicating potential toxicity.
Findings:
- Theophylline toxicity can occur even with moderately increased blood levels during chronic administration.
- Co-administration of anti-histamine drugs (anti-H1) with theophylline may increase the risk of severe poisoning.
- The patient recovered fully after receiving supportive care, including IV fluids and clonazepam.
Implications:
- This case underscores the importance of comprehensive medication review to prevent dangerous drug interactions.
- Healthcare providers must be vigilant about potential theophylline toxicity when prescribing concomitant medications.
- Enhanced patient monitoring is recommended for individuals on chronic theophylline therapy, particularly when other drugs are introduced.
Background:
Chronic administration of theophylline can be used for treating asthma; it may represent a severe risk when some other drugs are prescribed by unaware physicians.
Case Report:
A 4 yr-8-mo-old boy was admitted suffering from status epilepticus which occurred 3 hours after vomiting. This patient had asthma and was given sustained-release formulation of theophylline and, independently by another physician, two anti-H1 drugs: ketotifen and mequitazine. Serum theophylline concentration measured 9 hours after the onset of vomiting was 28 micrograms/ml; the calculated concentrations were 45.3 +/- 4, 40.2 +/- 4 and 33.4 +/- 4 micrograms/ml after the last administration of theophylline, the onset of vomiting and the onset of seizures, respectively. The patient was given IV fluids plus clonazepam and recovered completely.
Conclusion:
Severe poisoning can be seen with moderately increased blood levels of theophylline when this drug is chronically administered. Association of other drugs such as anti-H1 could represent an additional risk.