Theophylline Enhanced Elimination

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Acute theophylline toxicity:

Acute charcoal hemoperfusion indications: Theophylline level >90 mcg/mL at any time.

Theophylline level >40 mcg/mL when combined with: Seizures

Hypotension, refractory to fluid loading Ventricular dysrhythmias Protracted vomiting, refractory to antiemetics Chronic theophylline toxicity:

Risks increase with advancing age, intercurrent illnesses/infections, and reduced hepatic perfusion.

No role for either emesis or orogastric lavage, unless to instill AC via orogastric tube. AC and MDAC for cardiovascular-stable patients.

Charcoal HP for unstable patients and for AC failures.

Monitor theophylline levels every 4-6 hours until <20 mcg/kg.

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