In acute theophylline poisoning hypokalaemia, hyperglycaemia, and other electrolyte disturbances may occur. These abnormalities have been attributed to catecholamine excess with intracellular movement of potassium and catecholamine-stimulated gluconeogenesis. Herein we describe a female teenager, who developed metabolic disturbances with significant toxic response to oral theophylline overdose in a suicide attempt. Severe hypokalaemia (1.8 mmol/L) was among the leading pathological findings, at peak theophylline concentration (68 mg/L). There was high plasma glucose (10.2 mmol/L). Creatinine-kinase was evidently abnormal (8.60 microkat/L) several hours post poisoning, while serum myoglobin was markedly elevated (74.8 microg/L) despite the decrease in the drug level. Ventricular arrhythmia with marked extra systoles has been confirmed on electrocardiograph. Finally, the patient recovered through intensive care management with theophylline level (21.1 mg/L) falling close to reference range after 48 hours, but relative hypokalaemia persisted despite potassium supplementations even after the drug level fall below detection limit. In conclusion, timely gastrointestinal decontamination, determination of serum drug levels in intervals, electrocardiography evaluation followed by treatment of arrhythmias, supportive care including balancing of metabolic disturbances, follow-up assessment of serum electrolytes, in particular potassium and creatinine-kinase parallel with myoglobin level assessment even after significant decrease in theophylline level are very important measures.

Ustav klinické biochemie a patobiochemie 2 LF UK a FNM Praha