Effective treatment of acute theophylline intoxication with both direct hemoperfusion and hemodialysis

Abstract

A 35-year-old female was transferred to our hospital by ambulance because of palpitation and general fatigue. She had taken 28, 000mg of sustained-release theophylline preparation for a suicide attempt 5 hours before admission. Blood pressure was 80/50mmHg and heart rate was 180/min. Blood examination demonstrated leukocytosis (10, 100/μL), hypokalemia (2.4mEq/L), hyperglycemia (283mg/dL) and respiratory alkalemia (PaCO₂; 19.4mmHg). Electrocardiogram showed sinus tachycardia but there was no ventricular arrhythmia. A short-term seizure occurred, but was improved by intravenous diazepam injection. Serum theophylline concentration on admission was 169.2μg/mL. We performed stomach lavage and administered 50g of activated charcoal powder. Four hours after admission, hemoperfusion using an activated charcoal column was performed for 3 hours and the serum theophylline concentration decreased to 124.1μg/mL. Then, we performed hemodialysis for 4 hours. At the same time, we injected lactate Ringer solution and furosemide to promote a forced excretion of theophylline. After hemodialysis, the serum theophylline concentration decreased to 29.2mg/μL and electrolyte abnormalities improved on the next day, the serum theophylline concentration further decreased to 5.4μg/mL and consciousness became alert. This patient also demonstrated rhabdomyolysis due to acute theophylline intoxication and the peak level of serum creatinine phosphokinase (CPK) was 108, 470IU/L 24 hours after taking the drug. She improved without developing acute renal failure due to rhabdomyolysis and was ambulatory when discharged on the 15^th hospital day.