Treatment of Theophylline Overdose

Abstract

To the Editor.— We disagree with the suggestion of Drs Dean and Brown that massive theophylline overdose may be safely treated without hemoperfusion or hemodialysis (1982; 248:1742). Their patient survived a theophylline overdose that produced a peak level of 203 μg/mL. However, her hospital course was precarious, complicated by severe hypotension, recurrent arrhythmias, and repeated grand mal seizures. Although not described in detail, one seizure, which required 20 mg of diazepam in 2.5-mg increments, was most likely prolonged. Prolonged seizures combined with hypotension may result in anoxic brain damage. 1 The patient's mild memory loss is not well characterized but raises the question of permanent neurological damage. The pharmacology and toxicology of theophylline have been extensively studied. Our experience at the San Francisco General Hospital and the San Francisco Bay Area Poison Control Center confirms the literature consensus, cited by Dean and Brown, that morbidity and mortality after theophylline overdose