Theophylline intoxication, clinical features, treatment and outcome: a case report and a review of the literature

Severe theophylline intoxication is a medical emergency that can lead to cardiac arrhythmias, convulsions and cardiovascular collapse not infrequently leading to permanent morbidity or mortality. We describe a 30-yr-old patient with a peak serum theophylline level of 87 mg/l treated with haemoperfusion using a coated charcoal-filled column. A review of the literature concerning theophylline toxicity, supportive care, outcome and the possible indications for the use of extracorporeal haemoperfusion is given. A summary of possible conservative measures is given. It is concluded that haemoperfusion is the extracorporeal treatment of choice and should be considered in case of theophylline serum levels above 80 mg/l even without signs of major toxicity. For certain patients with conditions increasing the risks of prolonged or severe toxicity even lower serum theophylline levels may warrant the use of haemoperfusion.