Theophylline toxicity: Successful management of a patient with distributive shock secondary to drug overdose

Chandrasekaran, V.P.; Parthasarathy, Anand; Muruga, Balaji; Senthamil,; Tharanesh,

doi:10.1016/j.ajem.2020.05.112

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…A possible direct underlying mechanism responsible for lipid emulsion resuscitation as an adjuvant drug in drug toxicity-induced cardiovascular collapse includes inhibited NO release (Lee and Sohn 2023). Thus, although theophylline is water-soluble (Log P: −0.02), lipid emulsion-induced stabilization of intractable distributive shock caused by theophylline toxicity observed in the previous case report may be due to lipid emulsion-mediated inhibition of endothelial NO production caused by toxic doses of theophylline (Chandrasekaran et al 2020;Lee and Sohn 2023). Based on these results, methylene blue, which is used to alleviate vasoplegic shock, may be effective in treating hypotension caused by theophylline toxicity (Jang et al 2013).…”

mentioning

confidence: 82%

Theophylline-induced endothelium-dependent vasodilation is mediated by increased nitric oxide release and phosphodiesterase inhibition in rat aorta

Park,

Lee,

Bae

et al. 2023

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This study aimed to examine the endothelial dependence of vasodilation induced by the phosphodiesterase inhibitor theophylline in isolated rat thoracic aortas and elucidate the underlying mechanism, with emphasis on endothelial nitric oxide (NO). The effects of various inhibitors and endothelial denudation on theophylline-induced vasodilation, and the effect of theophylline on vasodilation induced by NO donor sodium nitroprusside, cyclic guanosine monophosphate (cGMP) analog bromo-cGMP, and β-agonist isoproterenol in endotheliumdenuded aorta were examined. The effects of theophylline and sodium nitroprusside on cGMP formation were also examined. We examined the effect of theophylline on endothelial nitric oxide synthase (eNOS) phosphorylation and intracellular calcium levels. Theophylline-induced vasodilation was greater in endothelium-intact aortas than that in endothelium-denuded aortas. The NOS inhibitor, N W -nitro-L-arginine methyl ester; non-specific guanylate cyclase (GC) inhibitor, methylene blue; and NO-sensitive GC inhibitor, 1H-[1,2,4]oxadiazolo [4,3-a] quinoxalin-1-one inhibited theophylline-induced vasodilation in endothelium-intact aortas. Theophylline increased the vasodilation induced by sodium nitroprusside, bromo-cGMP, and isoproterenol. Theophylline increased cGMP formation in endothelium-intact aortas, and sodium nitroprussideinduced cGMP formation in endothelium-denuded aortas. Moreover, theophylline increased stimulatory eNOS (Ser1177) phosphorylation and endothelial calcium levels, but decreased the phosphorylation of inhibitory eNOS (Thr495). These results suggested that theophylline-induced endothelium-dependent vasodilation was mediated by increased endothelial NO release and phosphodiesterase inhibition.

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confidence: 82%

Theophylline-induced endothelium-dependent vasodilation is mediated by increased nitric oxide release and phosphodiesterase inhibition in rat aorta

Park,

Lee,

Bae

et al. 2023

gpb

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“…In this patient, prompt lipid emulsion administration led to an early recovery from shock. 15 Jones and Taylor demonstrated a case of a 43year-old asthmatic female with unstable asthma was steroid-dependent and used salbutamol up to 30 times per day. Her asthma control significantly improved after cutting back on her beta-agonist use, and she was able to successfully cease taking oral steroids.…”

Section: Diagnosis and Management; Evidence From Literaturementioning

confidence: 99%

Diagnosis, complication and treatment of acute salbutamol toxicity

Baik

Alessa²,

Mohammed

et al. 2022

Int J Community Med Public Health

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Salbutamol is a well-known example of a short-acting beta agonist that is used as therapy for managing asthma, bronchospasm and chronic obstructive pulmonary disease. Short-acting beta agonist without a controller should only be taken into consideration as needed if symptoms are minimal and there is no asthma-related awakening. Salbutamol's maximal efficacy is based on how it is administered and the formulation that is utilized. Inhaled salbutamol is a first-line treatment for the majority of patients because it provides quick bronchodilation and typically relieves bronchospasm within minutes. Salbutamol immediately relieves the symptoms of acute asthma by relaxing the smooth muscle in the airways and boosting airflow. Patient experiences immediate relief from coughing, wheezing, tightness in the chest, and shortness of breath. Salbutamol's fast alleviation of symptoms may encourage abuse and overuse, especially in adolescents. On the basis of clinical and laboratory results, the diagnosis of salbutamol toxicity can be formed. The management is primarily supportive and includes stopping the harmful agent and using beta blockers to relieve symptoms. The purpose of this research is to review the available information about diagnosis, complication and treatment of acute salbutamol toxicity. Salbutamol overdose may cause tremors, hyperglycemia, lactic acidosis, and cardiac arrhythmias. Treatment for patients with severe symptoms include administration of beta-blockers if there are no contraindications also potassium supplementation, activated charcoal and gastric lavage among commonly used therapeutic strategies. Although salbutamol toxicity is uncommon still the physicians shall be knowledgeable about the diagnosis and management of salbutamol toxicity due to its widespread usage.

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“…Methylxanthines are derivatives of plant alkaloids that include caffeine, theobromine and theophylline, which have common medicinal properties and clinical effects 1. Theophylline is a bronchodilator drug that has been widely used in the treatment of asthma and obstructive lung diseases 2 . The use of theophylline has decreased due to its narrow therapeutic window and the development of safer drugs 3 .…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Survey of Theophylline Poisoning in a tertiary poison center

BAROONİAN,

RAMEZANİ,

ERFAN TALAB EVİNİ

et al. 2023

Eurasian Journal of Toxicology

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Background: Theophylline belongs to the category of bronchodilators and belongs to the family of methylxanthines. The purpose of this study was the epidemiological and clinical investigation of theophylline poisoning in patients admitted to Loghman Hakim Hospital in Tehran. Methods: This retrospective study reviewed the archived files of hospitalized patients from 2012 to 2022 by developing a questionnaire. All demographic information and results of examinations and laboratory tests were extracted from the files. The collected data were analyzed by SPSS version 25 software. Results: The age range of the patients was 3 months to 57 years. Out of 34 studied patients, 79.4% were female and 20.6% were male. The most common symptoms of poisoning were vomiting, nausea, sinus tachycardia, hyperglycemia and respiratory alkalosis. The incidence of hyperglycemia was 47.1%. One person had died. Conclusion: Poisoning with theophylline is uncommon and is mainly caused by self-harm. Except in severe poisonings, death and serious complications have not followed, and they have mostly recovered with supportive and symptomatic treatments.

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Theophylline toxicity: Successful management of a patient with distributive shock secondary to drug overdose

Cited by 10 publications

References 18 publications

Theophylline-induced endothelium-dependent vasodilation is mediated by increased nitric oxide release and phosphodiesterase inhibition in rat aorta

Theophylline-induced endothelium-dependent vasodilation is mediated by increased nitric oxide release and phosphodiesterase inhibition in rat aorta

Diagnosis, complication and treatment of acute salbutamol toxicity

Epidemiological Survey of Theophylline Poisoning in a tertiary poison center

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