A woman in her twenties was transported to our facility after losing consciousness in public. The patient claimed to have swallowed approximately 40 pills and had a history of schizophrenia, mood disorder, panic disorder and asthma. Current medications included paroxetine, amitriptyline and other drugs. On arrival, consciousness level was GCS E1V1M5, blood pressure 107/36mmHg, and heart rate 132bpm. The patient was treated for suspected overdose of tricyclic antidepressants, but symptoms including polyuria, hypokalemia, and lactic acidosis persisted. Theophylline was part of the differential diagnosis for drugs potentially causing lactic acidosis, and a second interview with the family clarified that the patient was receiving 200mg of theophylline. Blood concentration of theophylline showed a toxic level of 88µg/mL and the patient was treated by continuous hemodiafiltration (CHDF) and was discharged on the Day 5. Low blood pressure, hypokalemia, and lactic acidosis are sometimes seen in theophylline toxicity. These features may assist in diagnosing Theophylline toxicity.
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