Relation between Theophylline Serum Level with ECG Changes and Poison Severity Score (PSS) Among Some Theophylline Intoxicated Patients in Menofia Poison Control Center (MPCC) A Prospective Study

Safaa Amin,Samy Hammad,Amira El Seidy,Nagwa Habib

doi:10.21608/ajfm.2013.19404

Safaa Amin, Samy Hammad + Show 2 more

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https://doi.org/10.21608/ajfm.2013.19404

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Abstract

There are numerous toxins and drugs that can cause, in overdose, ECG changes, even in patients without history of cardiac pathology. Theophylline intoxication results in substantial morbidity and mortality, particularly in those with chronic overmedication. The aim of this work was to study ECG changes in cases of poisoning by theophylline overdose that were admitted to MPCC over 2011 and the relation between ECG changes, theophylline blood level and poison severity score. In this study, theophylline overdose patients admitted to MPCC in the period from 1st of January 2011 to 31st of December 2011 were included. The total patients' number was 44 patients. Most cases of the study were females (77.2%) in the age group of (20-<40) years (40.9%), mainly from rural side (65.9%). Regarding relation between theophylline serum level and clinical manifestations, a significant relation was found between serum level and each of vomiting and dizziness, where both were noticed with majority of cases of minimal and moderate toxicity serum level. Regarding poison severity score, exactly one half of moderate and severe cases had minimal toxicity serum level, and the other half had moderate toxicity level. A significant negative correlation between theophylline serum level and PCO2 was found. There was a non significant negative correlation between theophylline serum level and each of Na and K blood level. Concerning ECG changes, a significant relation was found between theophylline serum level and each of sinus tachycardia and second degree heart block.

Highlights

There are numerous toxins and drugs that can cause, in overdose, ECG changes, even in patients without history of cardiac pathology (Lionte et al, 2012)
Table (2) demonstrated the relation between mode of exposure and both age and gender, where accidental poisoning was detected in the age group 5-
In regard to ECG changes, a significant correlation was found between theophylline serum level and sinus tachycardia; which was evident in all cases of moderate toxicity level, 74.3% of cases with minimal toxicity theophylline serum level, and in 20% of cases with therapeutic level. 2nd degree heart block was evident in 25% of cases with moderate toxicity theophylline level

Summary

Introduction

There are numerous toxins and drugs that can cause, in overdose, ECG changes, even in patients without history of cardiac pathology (Lionte et al, 2012). The occurrence of adverse effects with theophylline, even at levels in the therapeutic range, and the severity of its effects in acute and chronic overdose are notable (Reillyand Stawicki 2008). The major clinical effects of theophylline at both therapeutic and overdose result from adenosine antagonism, release of endogenous norepinephrine, and consequent adrenergic receptor stimulation and phosphodiesterase inhibition (Hoffman, 2006). Theophylline toxic reactions including nausea, vomiting, headache, diarrhea, irritability and insomnia, increase if the theophylline level exceeds 20μg/ml. Hyperglycemia, hypokalemia, hypertension and cardiac arrhythmia may be observed at these higher levels (Visitsunthorn et al, 2001; Yoshikawa, 2007; Lionte et al, 2012).

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