Toxicity of salbutamol and theophylline together

Fatal theophylline poisoning with rhabdomyolysis. A potential role for dantrolene treatment

A fatal case of theophylline poisoning is described. The patient developed rhabdomyolysis, renal failure and compartment syndrome, as well as the more usual features of severe theophylline poisoning. Dantrolene appeared to be useful in controlling the hypermetabolic state associated with the overdose and may have a role in future treatment.

The assessment and treatment of theophylline poisoning

Theophylline poisoning long has been recognized as difficult to treat and still has an over-all mortality rate of about 10%. In recent years, the increasing use of sustained-release preparations has changed the pattern of toxicity. The management of theophylline toxicity is compounded by clinical differences between chronic (overmedication) intoxication and acute single ingestions of a large amount of the drug, inter- and intraindividual variability in theophylline metabolism and dose-dependent kinetics in poisoned patients. Management decisions should be based on both clinical assessment and laboratory information (particularly theophylline concentrations).

Aminophylline toxicity--how many hospital asthma deaths does it cause?

Aminophylline administration was compared in 43 patients who died from asthma and 43 matched controls who were admitted, suffering from acute asthma, to hospitals in the North East Thames Region. A computer program, which used information about individual characteristics, medical history and drug intake, was employed to calculate the serum theophylline levels which were likely to have resulted from the hospital treatment each patient received. Toxic theophylline levels were estimated to have occurred in 21% (9/43) of fatal cases and 7% (3/43) controls. Details of four patients who died when their serum theophylline levels were likely to have been very high are presented. Six fatal cases suffered gastro-intestinal bleeds during their final illness: four of these had theophylline levels which were calculated to have been toxic at the time of bleeding.

Methylxanthines: toxicity to humans. 1. Theophylline

While there are several comprehensive reviews on the toxic effects of theophylline, caffeine and theobromine in animals, data on the toxicity of these methylxanthines in humans have not been extensively reviewed in one document. This question will be addressed in a series of three papers. This paper provides an overview of the human toxicity of theophylline. Only pertinent and recent information on theophylline toxicity is summarized. In addition, some information regarding the use and benefits of theophylline, the mechanism of its effects and factors that affect variability in its clearance and half-life is also provided. Some problems in the analytical methodology of theophylline, problems that may be responsible for the controversy in the reported dose-response effects, are critically reviewed.

Theophylline poisoning. Pharmacological considerations and clinical management

The recent marketing of slow release preparations of theophylline and new indications for the use of the drug have resulted in a marked increase in the sale of theophylline products. This phenomenon combined with the drug's highly variable pharmacokinetics has led to an increase in the number of theophylline intoxications. The morbidity and mortality rates associated with theophylline intoxication are significant. Therefore it is essential that clinicians are aware of the pathophysiology, clinical presentation and treatment of this poisoning. Theophylline intoxication mainly affects the gastrointestinal, cardiovascular and central nervous systems. Signs and symptoms range from mild gastrointestinal upset to serious central nervous system manifestations such as seizures, a symptom often associated with a bad prognosis. Theophylline serum concentrations are very useful for making decisions regarding treatment. However, their interpretation should take into account several factors such as the age of the patient and the type of intoxication (acute versus chronic). Prevention of gastrointestinal absorption should be the principal objective of treatment of an oral theophylline poisoning. The repetitive administration of activated charcoal not only prevents theophylline absorption but also increases its rate of Once absorbed, external methods such as haemodialysis and haemoperfusion can significantly accelerate the elimination of the drug from the body. Finally, the rapid suppression of seizures and cardiac arrhythmias are essential to prevent severe neurological sequelae and death. Since theophylline intoxication can be potentially life-threatening, its administration should be monitored with regular measurements of the serum theophylline concentration, especially in the very young and the very old.

Treatment of severe poisoning with slow release theophylline

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Benefit of hemoperfusion in acute theophylline intoxication

Charcoal and resin hemoperfusion or hemodialysis can accelerate theophylline elimination. Their benefit in the treatment of poisoned patients has been accepted on the basis of case reports. We reviewed the treatment of 26 patients with acute theophylline intoxication to determine how much of an effect hemoperfusion or hemodialysis had on the hospital course and outcome of the overdose. Eighteen patients received supportive care and eight patients hemoperfusion (HP) or hemodialysis (HD). The HP/HD patients had more severe theophylline intoxication on the basis of admission and peak theophylline levels, degree of hypotension and occurrence of arrhythmias. During HP/HD, theophylline concentrations decreased, heart rate slowed, blood pressure increased and evidence of central nervous system effects diminished. Despite the severe intoxication in the HP/HD groups, duration of clinical toxicity was shorter (13.5 +/- 7.1 vs. 21.6 +/- 14.1 hr) than in the control group. Seizures occurred in patients in both groups, but there was higher mortality or neurological morbidity in the supportive care (3/4) than in the HP/HD (1/5) group. Our study provides evidence that HP/HD can reduce the duration of clinical intoxication and probably reduces mortality and morbidity in patients with severe theophylline intoxication.