Massive theophylline overdose. Rapid elimination by charcoal hemoperfusion

Area of Science:

• Pharmacology
• Toxicology
• Nephrology

Background:

• Theophylline is a medication used for respiratory diseases.
• Theophylline overdose can lead to severe toxicity, including seizures and cardiac arrhythmias.
• Effective removal methods are crucial for managing theophylline toxicity.

Observation:

• A patient ingested 8.5 g of theophylline, developing shock, seizures, and cardiac arrhythmias.
• Charcoal hemoperfusion was initiated to manage the severe theophylline toxicity.
• Serum theophylline concentration decreased from 170 to 20 mg/ml within six hours of treatment.

Findings:

• Uncoated charcoal columns demonstrated nearly 100% extraction efficiency for theophylline.
• The maximum charcoal clearance rate was 163 ml/kg/hr, significantly higher than endogenous clearance (50 ml/kg/hr) or hemodialysis (24.3 ml/kg/hr).
• Charcoal hemoperfusion rapidly and efficiently removed theophylline from the patient's serum.

Implications:

• Charcoal hemoperfusion is a highly effective method for managing severe theophylline toxicity.
• This intervention can rapidly reduce life-threatening serum theophylline concentrations.
• Consideration of charcoal hemoperfusion is warranted in cases of significant theophylline overdose.