Theophylline toxicity: Undiagnosed patient survives in ED case report
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Theophylline toxicity: A case report of the survival of an undiagnosed patient who presented to the emergency department
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Nasir Mohamad, Nurkhairul Nizam Abd Halim, Rashidi Ahmad, Kamarul Aryffin Baharuddin
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Theophylline toxicity: A case report of the survival of an undiagnosed patient who presented to the emergency department
Year: 2009
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Theophylline toxicity presents a significant challenge in emergency medicine due to its life-threatening nature and overlapping clinical features with other toxidromes. This specific case details a 22-year-old male who presented with altered mental status after ingesting a substantial quantity of theophylline tablets, initially misdiagnosed as chlorpheniramine toxicity. The patient's condition included seizures and severe tachycardia, leading to the need for intensive care and advanced supportive measures. This experience underscores the criticality of accurate toxidrome diagnosis in emergency settings as it directly influences patient outcomes.
Importance of Accurate Diagnosis in Toxicology
Timely and accurate diagnosis of drug toxicity is essential for effective treatment. In this case, the patient exhibited signs that were not consistent with the typical toxicity profile of chlorpheniramine, such as moist skin and altered mental status, which are indicative of a potential theophylline overdose. The overlap of clinical features among various toxidromes necessitates thorough patient history-taking, physical examination, and early toxicology screening to guide management decisions. In cases of theophylline toxicity, interventions like activated charcoal and monitoring of metabolic parameters (e.g., hypokalaemia, hyperglycaemia) should be prioritized to facilitate better elimination of the drug and improve the patient's condition.
Conclusion
This case reinforces the importance of proper toxicological assessments in the emergency department and highlights the risks associated with common drugs like theophylline, which possesses a narrow therapeutic index. The experience garnered from managing an undiagnosed theophylline toxicity case serves as a cornerstone for improving practices and protocols in future poisonings. Ultimately, a swift and accurate diagnosis combined with appropriate clinical interventions can lead to improved patient outcomes and potentially save lives in emergency situations involving drug toxicity.
FAQ section (important questions/answers):
What is theophylline and why is it significant in medicine?
Theophylline is a drug commonly used for treating acute or chronic lung diseases. Its narrow therapeutic index poses a risk for toxicity, which can lead to serious health complications, including seizures and dysrhythmias.
What are some symptoms of theophylline toxicity?
Symptoms of theophylline toxicity can include altered mental status, seizures, tachycardia, nausea, vomiting, abdominal pain, and hypotension. These symptoms may overlap with other drug toxicities, making diagnosis challenging.
How is theophylline toxicity managed in the emergency department?
Management includes accurate diagnosis through a thorough history, physical examination, and early serum toxicology screening. Activated charcoal is often administered to reduce drug absorption, and if severe, extracorporeal elimination methods like hemoperfusion may be considered.
What was notable about the presented case in the report?
The case involved a young male with undiagnosed theophylline toxicity following an overdose. Despite initial treatment for presumed chlorpheniramine toxicity, he required intensive care due to seizures and significant cardiovascular instability.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Theophylline toxicity: Undiagnosed patient survives in ED case report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Toxicity:
Toxicity refers to the degree to which a substance can cause harm to an organism. In the context of theophylline, it highlights how therapeutic doses can become harmful due to its narrow therapeutic index. Understanding toxicity is crucial in emergency medicine for accurate diagnosis and timely intervention to prevent severe outcomes.
2) Blood:
Blood is vital for transporting oxygen, nutrients, and hormones throughout the body. In cases of toxicity, blood tests provide information about levels of toxic substances like theophylline, renal function, and metabolic abnormalities. Monitoring blood parameters helps guide treatment and assess the patient’s response to therapeutic interventions.
3) Drug:
A drug is any substance that, when introduced into the body, alters physiological function. Theophylline, as a drug, is used primarily for respiratory conditions. However, errors in dosage or overdose can lead to toxicity, making it essential for healthcare providers to be vigilant regarding drug management and patient safety.
4) Toxicology:
Toxicology is the study of the effects of toxic substances on living organisms. In emergency medicine, a solid understanding of toxicology is crucial for diagnosing and managing cases of overdose or intoxication. It aids in recognizing symptoms, understanding mechanisms of action, and developing effective treatment strategies to mitigate harm.
5) Table:
Tables in medical literature typically present data in a structured format for easy reference. In this case, tables show the serial monitoring of arterial blood gases, theophylline levels, and blood urea and electrolytes. They serve as critical tools for physicians to track changes over time and inform clinical decisions.
6) Life:
Life is the condition that distinguishes animals and plants from inorganic matter, characterized by growth, reproduction, and response to stimuli. In medical contexts, preserving life is the foremost goal, especially in acute situations like theophylline toxicity, where rapid intervention is necessary to prevent potentially fatal consequences.
7) Post:
Post refers to the period following an event. In medical contexts, it often describes follow-up care or observations after treatment. For example, monitoring serum theophylline levels post-ingestion is crucial to assess recovery and adjust therapeutic strategies based on the patient’s response and metabolic status.
8) Vomiting:
Vomiting is the forceful expulsion of contents from the stomach, commonly occurring in response to toxins. In cases of theophylline toxicity, it is a significant symptom that can complicate the clinical picture. Addressing vomiting is important to prevent aspiration and further electrolyte imbalances during treatment.
9) Medicine:
Medicine is the science and practice of diagnosing, treating, and preventing illness. It encompasses various fields, including pharmacology and toxicology. Understanding the clinical implications of drug toxicity, like that of theophylline, is crucial in medicine, requiring multidisciplinary knowledge for effective patient management and improved health outcomes.
10) Sign:
A sign in medicine refers to any objective evidence of a disease observed by a healthcare provider. In toxicology, signs may include vital sign abnormalities like tachycardia or altered mental status from toxicity. Identifying these signs promptly can significantly influence diagnosis and treatment strategies in emergencies.
11) Pain (Paiṇ):
Pain is a distressing sensory experience often associated with injury or illness. In the reported case, abdominal pain was a symptom of theophylline toxicity. Understanding patient pain helps guide diagnosis and dictate treatment, as addressing pain is often integral to improving patient comfort and overall recovery.
12) Knowledge:
Knowledge, particularly in toxicology and pharmacology, is essential for healthcare practitioners to manage drug toxicity effectively. Familiarity with the symptoms, treatment protocols, and potential complications associated with drugs like theophylline informs clinical decision-making and can lead to better patient outcomes in emergencies.
13) Nausea:
Nausea is an unpleasant sensation often preceding vomiting. In the case of theophylline toxicity, nausea was a prominent symptom that guided clinicians in the diagnostic process. Understanding nausea's role in assessing toxicity can lead to appropriate interventions and improve patient comfort and management in emergency settings.
14) Pulse:
Pulse refers to the rhythmic expansion and contraction of arteries as blood is pumped by the heart. In the context of theophylline toxicity, monitoring pulse rate provides insights into cardiovascular status, aiding in the assessment of symptoms like tachycardia or hypotension, which are critical for patient management.
15) Pharmacotherapy:
Pharmacotherapy is the treatment of disease through the administration of drugs. In instances of drug toxicity, like theophylline overdose, pharmacotherapy can include the use of antidotes, supportive care, and symptom management to reverse toxicity effects, emphasizing the importance of appropriate drug use and monitoring.
16) Disease:
Disease constitutes a pathological condition characterized by specific symptoms or signs. Understanding the relationship between diseases, such as those affecting respiratory function that may require theophylline, is crucial in recognizing potential toxicological issues and ensuring effective treatment pathways in medical practice.
17) Family:
Family refers to the social unit of individuals related by blood or marriage. In medical emergencies involving toxic exposures, family members often provide critical history and context about the patient’s condition. Their involvement can help guide treatment decisions and facilitate support throughout the recovery process.
18) Animal:
Animal studies are significant in toxicology, providing insights into the pharmacodynamics and toxicity of substances before human applications. They contribute to understanding how drugs like theophylline affect different biological systems, informing safer therapeutic uses and potential toxicological consequences observed in clinical settings.
19) Dashta (Daṣṭa, Ḍasṭa):
Dasta refers to Dasta JF, a researcher referenced in the context of theophylline pharmacotherapy. Understanding her contributions is important as they help shape clinical practices surrounding the use of theophylline and its management in cases of toxicity, influencing treatment protocols and improving patient outcomes.
20) Sugar:
Sugar, specifically glucose, plays a vital role in metabolism and energy production in the body. Monitoring blood sugar levels is significant in cases of drug toxicity, where metabolic imbalances can occur. In the case presented, elevated sugar levels may guide treatment strategies in managing the patient’s condition.
21) Food:
Food provides essential nutrients and energy for survival. In the context of poisoning, the contents of the stomach, including food, are relevant during assessment and treatment. In the case of theophylline toxicity, the presence of food in vomitus can affect the management strategies employed post-ingestion.
22) Ter:
Ther seems incomplete but can refer to therapeutic interventions. In discussions of toxicity, understanding therapeutic measures for conditions like theophylline overdose is crucial. Identifying the appropriate therapeutic approach can significantly affect patient outcomes, emphasizing evidence-based practices in managing drug toxicity effectively.
23) Pur (Pūr):
Poor in a medical context often refers to suboptimal health status, which may stem from various factors such as improper medication dosing or underlying conditions. In the case of theophylline toxicity, 'poor' can describe the patient's clinical state, guiding clinicians to aggressively implement interventions to improve health outcomes.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Theophylline toxicity: Undiagnosed patient survives in ED case report’. Further sources in the context of Science might help you critically compare this page with similair documents:
Mental Function, Medical science, Acute or chronic, Physical examination, Clinical feature, Supportive care, Case report, Acute Renal Failure, Neurotoxicity, Blood urea, Renal function, Electrocardiogram, Renal failure, Intensive care unit, First Pass Metabolism, Emergency medicine, Activated Charcoal, Gastric Lavage, Narrow therapeutic index, Emergency Department, Sustained release formulation, Toxicology screening, Altered mental status, Interstitial nephritis, Accurate diagnosis, Supraventricular tachycardia, Drug toxicities, Metabolic alkalosis, High-dependency unit, Metabolic response, Gastrointestinal Decontamination, Extracorporeal elimination.
Concepts being referred in other categories, contexts and sources.