Treatment of theophylline intoxication

Goldberg, Monica V.; Park, Glen D.; Berlinger, William G.

doi:10.1016/0091-6749(86)90066-7

Cited by 33 publications

(4 citation statements)

References 37 publications

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“…Other authors have made similar recommendations, although the threshold serum theophylline concentration for haemoperfusion has varied from 80 mg/l to 100 mg/I. 4,7,8,15,16 The experience of our series supports this selective use ofhaemoperfusion. Although well recognised as complications ofhaemoperfusion, we did not experience any clinically significant problems with hypocalcaemia, neutropenia or thrombocytopenia.…”

Section: Discussionsupporting

confidence: 62%

Management of Theophylline Overdose Patients in the Intensive Care Unit

Henderson

Wright

Pond

1992

Anaesth Intensive Care

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In a retrospective survey of all adults admitted to the Intensive Care Unit with acute theophylline poisoning over the last five years, we identified 38 patients (6.8% of all admissions for poisoning), two of whom died. Thirty-five (92%) had taken a sustained-release preparation. Eight patients had grand mal seizures and six developed arrhythmias (ventricular fibrillation, 3; atrial fibrillation, 2; supraventricular tachycardia, 1). Severe vomiting was present in 34 (89%) and proved to be a serious obstacle to the administration of enteral charcoal. The vomiting was controlled by intravenous metoclopramide in seventeen patients (50%), but the remaining seventeen required mechanical ventilation with sedation and muscle relaxation for the effective delivery of nasogastric charcoal. Importantly, in nine (24%), the serum theophylline concentration continued to rise despite enteral charcoal. Charcoal haemoperfusion was used in seven (18%). We present an algorithm for the management of severe, acute theophylline poisoning.

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Section: Discussionsupporting

confidence: 62%

Management of Theophylline Overdose Patients in the Intensive Care Unit

Henderson

Wright

Pond

1992

Anaesth Intensive Care

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“…In the case of hPSC-CMs, two groups of treatment concentrations were determined according to the literature ( Aslaksen et al, 1981 ; Goldberg et al, 1986 ; Rowe et al, 1988 ; Higgins et al, 1995 ; Shannon, 1999 ). The “therapeutic concentration/overdose” group consisted of 10 µM, 100 µM, and 1 mM of aminophylline treatments, while the 10-mM aminophylline treatment was considered “severe overdose” concentration.…”

Section: Resultsmentioning

confidence: 99%

Aminophylline Induces Two Types of Arrhythmic Events in Human Pluripotent Stem Cell–Derived Cardiomyocytes

et al. 2022

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Cardiac side effects of some pulmonary drugs are observed in clinical practice. Aminophylline, a methylxanthine bronchodilator with documented proarrhythmic action, may serve as an example. Data on the action of aminophylline on cardiac cell electrophysiology and contractility are not available. Hence, this study was focused on the analysis of changes in the beat rate and contraction force of human pluripotent stem cell–derived cardiomyocytes (hPSC-CMs) and HL-1 cardiomyocytes in the presence of increasing concentrations of aminophylline (10 µM–10 mM in hPSC-CM and 8–512 µM in HL-1 cardiomyocytes). Basic biomedical parameters, namely, the beat rate (BR) and contraction force, were assessed in hPSC-CMs using an atomic force microscope (AFM). The beat rate changes under aminophylline were also examined on the HL-1 cardiac muscle cell line via a multielectrode array (MEA). Additionally, calcium imaging was used to evaluate the effect of aminophylline on intracellular Ca2+ dynamics in HL-1 cardiomyocytes. The BR was significantly increased after the application of aminophylline both in hPSC-CMs (with 10 mM aminophylline) and in HL-1 cardiomyocytes (with 256 and 512 µM aminophylline) in comparison with controls. A significant increase in the contraction force was also observed in hPSC-CMs with 10 µM aminophylline (a similar trend was visible at higher concentrations as well). We demonstrated that all aminophylline concentrations significantly increased the frequency of rhythm irregularities (extreme interbeat intervals) both in hPSC-CMs and HL-1 cells. The occurrence of the calcium sparks in HL-1 cardiomyocytes was significantly increased with the presence of 512 µM aminophylline. We conclude that the observed aberrant cardiomyocyte response to aminophylline suggests an arrhythmogenic potential of the drug. The acquired data represent a missing link between the arrhythmic events related to the aminophylline/theophylline treatment in clinical practice and describe cellular mechanisms of methylxanthine arrhythmogenesis. An AFM combined with hPSC-CMs may serve as a robust platform for direct drug effect screening.

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“…Further reports suggest that peak serum theophylline concentrations were a predictor of toxicity [55][56][57]. Even so, no consensus guidelines existed for when to employ hemoperfusion, with threshold serum theophylline levels ranging from 330 (59.4) to 550 μmol/L (99 μg/mL) [10,58,59]. Recommendations made by Park et al and revised by Goldberg et al suggest that hemoperfusion be performed in patients with a serum theophylline concentration greater than 80 μg/mL following an acute intoxication and in those with a serum level greater than 60 μg/mL with a chronic ingestion.…”

Section: What Are the Indications For Hemodialysis Or Hemoperfusion Fmentioning

confidence: 99%

“…Recommendations made by Park et al and revised by Goldberg et al suggest that hemoperfusion be performed in patients with a serum theophylline concentration greater than 80 μg/mL following an acute intoxication and in those with a serum level greater than 60 μg/mL with a chronic ingestion. They further suggested that those who could not tolerate oral charcoal were older than 60 years of age or had concurrent heart and liver dysfunction were at increased risk [58][59][60][61]. Extracorporeal elimination should be begun prior to onset of major toxicity involving seizures or dysrhythmias, since once these complications are present the use of enhanced elimination has not been shown to terminate such events [42].…”

Section: What Are the Indications For Hemodialysis Or Hemoperfusion Fmentioning

confidence: 99%

Combined Butalbital/Acetaminophen/Caffeine Overdose: Case Files of the Robert Wood Johnson Medical School Toxicology Service

Bryczkowski

Geib

2012

J. Med. Toxicol.

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A 40-year-old woman with no previous medical problems presented to the Emergency Department (ED) 2 h after ingesting an unknown amount of Fioricet® (butalbital/acetaminophen/caffeine), oxycodone, and fentanyl patches about 90 min prior to emergency medical service (EMS) dispatch. The patient's husband reported they had had a fight, and he went down to the basement; when he came back upstairs, he found the patient unconscious with an empty pill bottle. A call to the patient's pharmacy by ED staff revealed that the patient had her prescription for butalbital/acetaminophen/caffeine tablets refilled 5 days earlier and that she had convinced the pharmacist to override the refill amount to dispense 540 tablets; according to the pharmacist, the patient stated she was going on a trip to Italy and needed a 6-month supply. EMS personnel removed a fentanyl patch (unknown strength) from her skin. The source of the fentanyl and the strength and formulation of the oxycodone were not recorded. Prehospital treatment included naloxone 4 mg IV without any noticeable clinical response, insertion of a nasal trumpet, and initiation of bag-valve-mask ventilation. A fingerstick glucose was 137 mg/dL.On arrival to the ED, the patient was unconscious with the following vital signs: blood pressure, 98/54 mmHg; pulse, 72 beats/min; respiratory rate, 14 breaths/min; and pulse oximetry, 100 % on a non-rebreather mask.

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Treatment of theophylline intoxication

Cited by 33 publications

References 37 publications

Management of Theophylline Overdose Patients in the Intensive Care Unit

Management of Theophylline Overdose Patients in the Intensive Care Unit

Aminophylline Induces Two Types of Arrhythmic Events in Human Pluripotent Stem Cell–Derived Cardiomyocytes

Combined Butalbital/Acetaminophen/Caffeine Overdose: Case Files of the Robert Wood Johnson Medical School Toxicology Service

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