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Clinical Chemistry 36: 398-399, 1990;
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Clinical Chemistry, Vol 36, 398-399, Copyright © 1990 by American Association for Clinical Chemistry

Massive theophylline overdose with atypical metabolic abnormalities

SH Eshleman and LM Shaw
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104.

We report a case of fatal theophylline overdose in a 16-year-old asthmatic boy who presented with seizures, respiratory arrest, and a theophylline concentration of 117 mg/L in serum. His hospital course was complicated by refractory hypotension and severe ischemic necrosis of skeletal muscle, bowel, and liver. The metabolic abnormalities observed early in his hospital course included severe hyperkalemia, hyperphosphatemia, hypermagnesemia, hypocalcemia, and profound metabolic acidosis. These metabolic abnormalities differ from those previously reported in cases of massive theophylline overdose. The metabolic abnormalities observed in this patient probably reflected his extensive ischemic tissue damage with release of intracellular ions and associated acidemia. Markedly increased catalytic activities of creatine kinase, aspartate aminotransferase, and alanine aminotransferase in serum were also noted.




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Copyright © 1990 by the American Association for Clinical Chemistry.