Severe theophylline poisoning treated with continuous venovenous hemodialysis in a child

Abstract

Theophylline poisoning generally occurs due to acute high dose intake as well as chronic intake of the medication. Toxicity symptoms can be seen with a plasma concentration of theophylline over 20 µg/ml. The consequences of theophylline toxicity include metabolic disturbances (hypokalemia, hyperglycemia, and metabolic acidosis), nausea, vomiting, and in severe cases seizures, cardiac arrhythmias, and death. Theophylline poisoning in children is rarely described in the literature. A 3-year-old girl was referred from another hospital to our pediatric intensive care unit (PICU) due to prolonged refractory status epilepticus and respiratory failure linked with severe theophylline poisoning. The patient was admitted to our PICU 24 hours after the patient took theophylline. The referring center could not measure the serum theophylline level. The patient's first serum theophylline level that was checked at admission was 54 µg/ml. We started continuous venovenous hemodialysis (CVVHD) 3 hours after PICU admission and the patient's theophylline level successfully decreased within 9 hours. The patient was discharged at the 40 th day of admission from our hospital with severe neurological disability. In conclusion, severe theophylline poisoning may be seen in children. We must consider CVVHD in critically ill children with severe theophylline poisoning.

Predictors for Intensive Care Unit Admission in Acute Theophylline Intoxicated Patients

“…Theophylline is a commonly used drug in the treatment of acute or chronic lung disease. Despite the considerable potential benefit of theophylline, its narrow therapeutic range and erratic absorption and elimination contribute to the potential for toxicity, which can have high morbidity and mortality (Yaman et al, 2016). Theophylline intoxication may be acute, acute on therapeutic or chronic (Henry and Minton, 2011).…”