Theophylline poisoning: Indications for extracorporeal removal

Type of overdose	Indications
Acute	Severe symptoms such as seizures, shock, or life-threatening arrhythmias (eg, ventricular tachycardia)* Theophylline level ≥100 micrograms/mL (555 micromol/L), regardless of symptoms Clinical deterioration despite optimal care A rising theophylline level despite optimal care^¶
Chronic	Severe symptoms such as seizures, shock, or life-threatening arrhythmias (eg, ventricular tachycardia)* Theophylline level ≥60 micrograms/mL (336 micromol/L) in patients between the age of 6 months and 60 years, regardless of symptoms Theophylline level >50 micrograms/mL (277 micromol/L) in infants <6 months old or adults >60 years of age

Consultation with a medical toxicologist is advised in patients with severe theophylline poisoning for whom hemodialysis is being considered. In the United States, contact a regional poison control center by calling 1-800-222-1222. For contact information for poison control centers in other countries, go to the World Health Organization website or refer to UpToDate topic on Society guidelines links: Regional poison control centers. For extracorporeal removal of theophylline, we suggest high-efficiency hemodialysis rather than hemoperfusion, or continuous renal replacement therapy (CRRT). In neonates who are too ill to withstand hemodialysis, hemoperfusion, or CRRT, triple volume exchange transfusions may be effective. For more detail, refer to UpToDate content on theophylline poisoning.

* Ideally, extracorporeal removal should be used to treat theophylline poisoned patients with the above elevations in serum levels before seizures or cardiac arrhythmias develop, because hemodialysis or hemoperfusion has not been shown to reliably terminate these life-threatening events.

¶ For example, if the initial level is ≥80 micrograms/mL (444 micromol/L), then one additional rising level that is measured 2 hours later or if the initial level is <80 microgram/mL (444 micromol/L), a subsequent level that rises above 80 microgram/mL (444 micromol/L).

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Theophylline poisoning: Indications for extracorporeal removal