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Pronounced metabolic response to modest theophylline overdose
M T Hagley1, S M Traeger, H Schuckman
1Department of Internal Medicine, Akron City Hospital, OH.
The Annals of Pharmacotherapy
|February 1, 1994
Summary
Even small amounts of theophylline can cause serious metabolic issues like hyperglycemia and lactic acidosis. Seek these abnormalities in suspected theophylline overdoses, even with low levels.
Area of Science:
- Clinical Toxicology
- Pharmacology
- Internal Medicine
Background:
- Theophylline is a common medication used for respiratory conditions.
- Theophylline overdose can lead to significant toxicity.
- Metabolic derangements are known complications of theophylline toxicity.
Observation:
- A case of an 18-year-old male presenting after a suicide attempt involving theophylline ingestion.
- The patient ingested 3g of theophylline, resulting in a peak concentration of 157 mumol/L.
- Despite the relatively low theophylline level, the patient exhibited severe metabolic abnormalities.
Findings:
- The patient developed leukocytosis, hypokalemia, hypomagnesemia, hypophosphatemia, hyperglycemia, and lactic acidosis.
- These metabolic abnormalities are typically associated with much higher theophylline concentrations.
- This case highlights that significant toxicity can occur even with lower-than-expected theophylline levels.
Implications:
- Clinicians should consider theophylline toxicity in patients presenting with unexplained metabolic abnormalities.
- Theophylline overdose should be suspected even with seemingly small ingestions, especially in suicide attempts.
- Prompt identification and management of these metabolic derangements are crucial for patient outcomes.