The Old Friend Ruthless Enemy - Theophylline Toxicity: A Case Report
Journal Title: The Journal of Pediatric Emergency and Intensive Care Medicine - Year 2020, Vol 7, Issue 1
Abstract
Theophylline is an old drug of modern medicine. Theophylline toxicity may develop both with acute or chronic intakes due to its narrow therapeutic index. We present a case of theophylline toxicity because of its severe and lethal cardiac and metabolic toxic effects and good response to extracorporeal and medical therapies. A 15-year-old girl with a history of multiple drug intake was admitted to our pediatric intensive care unit due to paracetamol overdose. Theophylline poisoning was suspected because of clinical signs of tachycardia, tachypnea, agitation and metabolic signs of hyperglycemia, hypophosphatemia, hypokalemia,and hypomagnesemia in the early course of hospitalization and blood sample was taken for the measurement of theophylline blood level. The patient was considered as having theophylline toxicity due to high theophylline blood level (112 μg/mL) and normal paracetamol blood level. The patient was intubated because of clinical deterioration, and midazolam for sedation and fentanyl for analgesia were started. Ventricular extrasystoles were detected and after a bolus injection, lidocain infusion was started. Dexmedetomidine and esmolol for tachycardia and levetiracetam for seizure prophylaxis and electrolyte replacement for metabolic disturbances were started as medical treatments. Continuous venovenous hemodialysis was administered for three days and therapeutic plasma exchange was performed for three times with 4% albumin solution (1.5 plasma volume in the first session) and fresh frozen plasma solutions (second and third sessions with one plasma volume). The patient was extubated on the third day and medical therapies were terminated on the fourth day of hospitalization. The patient was discharged on fifth day of hospitalization to the pediatric ward.
Authors and Affiliations
Hasan Serdar Kıhtır, Zeynep Gör, Tuğçe Ekşi Aygün, Ebru Çelebi, Seda Aras, Zeynep Kıhtır
Keywords
Related Articles
- EP ID EP684290
- DOI 10.4274/cayd.galenos.2018.14622
- Views 192
- Downloads 0
Four Traumatic Asphyxial Cases with an “Masque Ecchymotique” in Pediatric Emergency Department
Traumatic asphyxia is a rare and serious clinical syndrome, which is identified by subconjunctival haemorrhage, facial oedema, craniocervical cyanosis and petechiae on the upper chest and the face regions. It occurs when...
Evaluation of Caregiving Burden in Caregivers of Children with Chronic Disease
Introduction: We aimed to evaluate the epidemiological characteristics of caregivers and caregiving burden of caregivers of children with chronic diseases who were admitted to the pediatric emergency unit and to evaluate...
Evaluation of Emergency Service Applications of Home Mechanical Ventilator Dependent Children
Introduction: There has been an increase in the number of patients using home mechanical ventilator for suffering from chronic respiratory failure, due to the recent technological developments and increasing experience....
A Child with Severe Paraesthesia due to Pyrethroid Exposure: Successful Treatment with Topical Vitamin E
Pyrethroids are one of the most common insecticides and have been known as safe household insecticides. They are highly toxic for insects whereas they are low in toxicity for mammals. Poisoning syndromes occur via oral,...
Anaphylaxis Due to Hydatid Cyst Rupture
Hydatid cyst disease is still endemic in our country. It may present with non-specific complaints such as abdominal pain and jaundice as well as anaphylactic reactions due to cyst rupture. In this report, we aimed to pre...