From the Guidelines
A 16-year-old girl who has ingested theophylline in a suicide attempt would likely present with symptoms of theophylline toxicity, including nausea, vomiting, abdominal pain, diarrhea, tachycardia, arrhythmias, hypotension, restlessness, agitation, tremors, seizures, and altered mental status. The severity of these symptoms depends on the amount of theophylline ingested, with serum levels above 20 mg/L considered toxic and levels above 40-60 mg/L potentially life-threatening 1.
Key Symptoms
- Gastrointestinal: nausea, vomiting, abdominal pain, diarrhea
- Cardiovascular: tachycardia, arrhythmias, hypotension, hypertension
- Neurological: restlessness, agitation, tremors, seizures, altered mental status
- Metabolic: hypokalemia, hyperglycemia, metabolic acidosis, hypophosphatemia
- Respiratory: tachypnea, respiratory alkalosis Theophylline toxicity occurs because the drug inhibits phosphodiesterase, leading to increased cyclic AMP and excessive catecholamine release, which explains many of the sympathomimetic effects observed 1.
Management
This patient requires immediate medical attention with:
- Activated charcoal administration
- Supportive care
- Cardiac monitoring
- Possibly hemodialysis in severe cases It is crucial to note that the management of suicidal behavior and theophylline toxicity should be done in a setting where adequate supervision and support are available, and the environment is "sanitized" by securing or disposing of potentially lethal medications and firearms 1.
From the FDA Drug Label
The frequency of various reported manifestations of theophylline overdose according to the mode of overdose are listed in Table IV Other manifestations of theophylline toxicity include increases in serum calcium, creatine kinase, myoglobin and leukocyte count, decreases in serum phosphate and magnesium, acute myocardial infarction, and urinary retention in men with obstructive uropathy Seizures associated with serum theophylline concentrations >30 mcg/mL are often resistant to anticonvulsant therapy and may result in irreversible brain injury if not rapidly controlled Death from theophylline toxicity is most often secondary to cardiorespiratory arrest and/or hypoxic encephalopathy following prolonged generalized seizures or intractable cardiac arrhythmias causing hemodynamic compromise
A 16-year-old girl who ingests her grandfather's theophylline in a suicide attempt may exhibit the following symptoms:
- Seizures: generalized seizures, which can be resistant to anticonvulsant therapy and may result in irreversible brain injury if not rapidly controlled
- Cardiac arrhythmias: life-threatening cardiac arrhythmias, which can cause hemodynamic compromise
- Gastrointestinal symptoms: nausea, vomiting
- Neurological symptoms: headache, insomnia, irritability, restlessness, fine skeletal muscle tremors
- Other symptoms: increases in serum calcium, creatine kinase, myoglobin and leukocyte count, decreases in serum phosphate and magnesium, acute myocardial infarction, and urinary retention 2 2
From the Research
Symptoms of Theophylline Overdose
The symptoms that a 16-year-old girl may exhibit after ingesting her grandfather's theophylline in a suicide attempt include:
- Hypokalaemia (low potassium levels) 3
- Hyperglycaemia (high blood sugar levels) 3
- Electrolyte disturbances 3
- Ventricular arrhythmia with marked extra systoles 3
- Gastrointestinal symptoms such as nausea and vomiting 4, 5, 6, 7
- Neurologic toxicities, such as seizures 4, 5, 6, 7
- Cardiac toxicities, such as arrhythmias and tachycardia 4, 5, 6, 7
- Metabolic derangements, such as elevated creatinine-kinase and myoglobin levels 3
Severity of Symptoms
The severity of the symptoms depends on the amount of theophylline ingested and the individual's sensitivity to the drug. Patients with initial serum concentrations of less than 60 mg/L may exhibit mild symptoms, while those with concentrations exceeding 100 mg/L may experience severe symptoms, including seizures and life-threatening cardiac arrhythmias 4, 7.
Treatment and Management
Treatment of theophylline overdose involves:
- Gastrointestinal decontamination 3, 4, 5, 6, 7
- Monitoring of serum drug levels and electrolytes 3, 4, 5, 6, 7
- Cardiac monitoring and seizure precautions 3, 4, 5, 6, 7
- Supportive care, including balancing of metabolic disturbances 3, 4, 5, 6, 7
- Elimination-enhancing modalities, such as oral activated charcoal, charcoal hemoperfusion, or hemodialysis, may be necessary in severe cases 4, 5, 6, 7