Citation

Kurczabińska-Luboń D, Nowicka M, Stołtny L, Luboń D, Lubina A, Karpel E. Anestezjol. Intens. Ter. 2005; 37(4): 251-254.

Copyright

(Copyright © 2005, Medi Press)

DOI

unavailable

PMID

unavailable

Abstract

Background. Suicidal poisoning with methylxanthines is difficult to treat, because of their low toxic-therapeutic index, and is associated with high morbidity and mortality. Toxic effects develop suddenly and include cardiac arrhythmias, cardiac arrest, neurological disturbances, hypokalaemia, rhabdomyolysis and severe metabolic acidosis. Case report. A 16-yr-old girl was admitted to the hospital after oral ingestion of 7.5 g of theophylline. On admission, she was consciousbut complaining of nausea, with tachycardia (140 bmp) and hypotension (80/50 mmHg). After 2 hours of observation, she lost consciousness and developed convulsions, followed by ventricular fibrillation and cardiac arrest. CPR was commenced, and after successful defibrillation, she was transferred to the ICU unconscious, dyspnoeic and hypotonic, with a supraventricular tachyarrhytmia. Theophylline concentration taken at admission was 106.6 μg ml-1; it increased to 125 μg ml-1 after 12 hours. She also developed severe metabolic disturbances: metabolic acidosis (BE - 20 mmol l-1), hypokalaemia (K+ 2.25 mmol l-1) and an extremely high serum creatine kinase (28 200 U l-1). The girl was sedated with thiopentone and placed on mechanical ventilation. Continuous haemodialysis was initiated. Sedation was stopped after 72 hours, but she remained in a deep coma for another three days. Computed tomography showed no lesion in the brain that would be responsible for her condition. Theophylline concentration decreased to 22 μg ml-1 after 48 hours and haemofiltration was successfully discontinued. An electrocardiogram showed persistent supraventricular arrhythmias. She slowly regained consciousness after 6 days of treatment. Mechanical ventilation was stopped on the next day and after 9 days of intensive care she was transferred to the neurology department to be treated for persistent muscle hypotonia, tremor and hyperalgesia.

DISCUSSION and conclusion. Clinical signs of methylxanthine intoxicatio n may develop suddenly and become life-threatening. Serum drug concentration is mandatory and continuous haemodialysis is a method of choice in such cases.

Language: pl

Keywords

adolescent; human; suicide; female; Cardiac arrest; resuscitation; case report; decision making; neurology; Drugs; Blood; article; drug intoxication; hospital admission; sedation; tachycardia; intensive care unit; coma; convulsion; drug blood level; intensive care; nausea; hypotension; heart arrest; computer assisted tomography; artificial ventilation; theophylline; clinical observation; creatine kinase; defibrillation; electrocardiogram; heart ventricle fibrillation; Toxicity; hemofiltration; enzyme blood level; metabolic acidosis; dyspnea; Complications; muscle hypotonia; unconsciousness; brain damage; consciousness level; continuous hemodialysis; Haemofiltration; hospital department; hypokalemia; methylxanthine derivative; supraventricular tachycardia; Theophylline; thiopental