ToxicologyEmergencyRespiratory
Theophylline / aminophylline overdose
Refractory tachyarrhythmia, seizures and hypokalaemia from theophylline — multi-dose charcoal and haemodialysis.
Source: TOXBASE/NPIS; AACT/EAPCCT; EXTRIP; BNF
Step 1 of ~6
warning
Identify acute vs chronic — they behave differently
Acute (single ingestion in non-toxic patient): vomiting, tachycardia, agitation, hypokalaemia, hyperglycaemia, hypophosphataemia, metabolic acidosis. Seizures and arrhythmias at higher levels.
Chronic (slow accumulation in established therapy): seizures and arrhythmias at LOWER levels; less hypokalaemia. Triggers: drug interactions (macrolides, ciprofloxacin, cimetidine), heart failure, infection, elderly.
ABCDE; continuous ECG; cardiac monitoring; large-bore IV access.
Bloods: theophylline level (peak 1–2 h IR, 4–8 h SR, repeat 4-hourly while rising), K⁺, Mg²⁺, glucose, U&E, VBG, lactate, paracetamol/salicylate, ECG.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
Same class
- Aminophylline IV · Xanthine bronchodilator (theophylline ethylenediamine)
- Dopamine (ICU — Vasopressor/Inotrope) · Catecholamine (Dose-Dependent Vasopressor/Inotrope)
- Acetylcysteine (N-acetylcysteine — Paracetamol Overdose) · Mucolytic / Hepatoprotective Antidote
- Hydroxocobalamin (High-Dose — Cyanide Antidote) · Cyanide Antidote (Vitamin B12 Precursor at High Dose)
- Dopamine hydrochloride · Inotrope / vasopressor (dose-dependent)
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.