Management of theophylline poisoning in children

Whether the degree of elevation of serum theophylline concentration should be used to guide management of theophylline poisoning remains controversial. Our objective is to evaluate the clinical features of theophylline poisoning in children, and to study the outcome as related to therapy. The records of all children admitted with a diagnosis of theophylline poisoning between January 1989 and December 1996 were reviewed. Thirty-seven patients with median age 10.6 years (range, 15 days - 17.4 years) were identified, 28 with acute and 9 with chronic toxicity. Peak theophylline level was 62 mg/L (21-146 mg/L) (344 mmol/L 117-810 mmol/L) in those with acute poisoning, and 37 mg/L(28-71 mg/L) (205 mmol/L 155-394 mmol/L) in the chronic group. Ten patients had theophylline levels > 80 mg/L (444 mmol/L). Common presenting signs/symptoms included vomiting (34), sinus tachycardia (32), tremors (19), headache (8) and hypotension (7). Only one patient, with a theophylline level of 28 mg/L (139 mmol/L) from chronic exposure, presented with brief seizures. Patients were managed with gastrointestinal decontamination, multiple-dose activated charcoal and intravascular volume expansion. Two patients (theophylline levels 122 and 146 mg/L (677 and 810 mmol/L) respectively) were additionally treated with charcoal hemoperfusion. The remaining patients with serum theophylline levels > 80 mg/L (444 mmol/L) were managed without hemoperfusion and achieved levels < 20 mg/L (111 mmol/L) within 17 hours (10-28 hours). There were no complications during management. All patients survived without neurologic sequelae. Severe theophylline poisoning can be safely and effectively managed in most patients with gastrointestinal decontamination, multiple-dose activated charcoal and intravascular volume expansion. Routine use of charcoal hemoperfusion based on serum theophylline concentration alone does not appear to be warranted.