02 Jan

Cardiac Arrhythmias during Theophylline Toxicity: Results (1)

Clinical Characteristics
Twenty-three adult patients with an initial STC greater than 30 mg/L were entered into the study (Table 1). Seven patients were excluded from analysis as a result of incomplete or technically unacceptable ECG recordings (n = 4), delayed initiation of ECG recording until STC had decreased to less than 20 mg/ L (n = 1), or premature discontinuation of ECG recording when STC remained greater than 20 mg/L (n = 2). Most of the 16 patients who had satisfactory recordings were older men with COPD and had toxicity due to chronic theophylline overmedication (ingested extra tablets over several days) as a result of patient or physician dosing error, similar to previous reports.- No patient experienced seizures or shock. All patients recovered from toxicity. The initial STC was 45.8 ± 12.9 mg/L. An average of 6 hours passed from the time the initial STC blood sample was obtained and when the ECG recorder was activated. The STC at the time of ECG recorder activation was 38 ± 13 mg/L (range, 23 to 67 mg/L). buy ortho tri-cyclen

Continuous Electrocardiographic Recording Results
An average of 21 hours of ECG recording was performed; 11 hours when STC was greater than 20 mg/L and ten hours when STC was less than 20 mg/L (Table 2).

Table 1—Clinical Characteristics of 16 Patients with Theophylline Toxicity

Patient No./ Underlying Etiology Theophylline STC,, Toxic STC,„
Age, yr/Sex Disorders of Toxicity Preparation mg/L Manifestations mg/L
1/73/M COPD Took extra SR 63.0 Nausea, vomiting, nervousness, tremor, hypokalemiat 66
2/19/M Asthma Overdose Primatenetablets .58.7 Nausea, vomiting, nervousness, hypokalemia, respiratory alkalosis 55
3/66/M COPD xs dose SR 31.1 Nervousness, tremor 29
4/36/M Asthma Overdose SR 55.0 Nervousness 32
5/65/M COPD Unknown SR 46.3 Nausea, vomiting, nervousness, tremor 28
6/70/M COPD, angina Erythromycin, xs dose SR 31.8 Tremor 30
7/67/M COPD, cor pulmonale xs dose, ranitidine Elixir 38.1 Nausea,nervousness, tremor, hypokalemia 30
8/48/F Renal transplant Wrong medication SR 48.4 Nausea, vomiting,nervousness,

hypokalemia

44
9/51/M COPD, angina Took extra SR 37.8 Nausea, vomiting, nervousness, tremor, hypokalemia 38
10/67/F COPD, hxsz xs dose SR 31.4 23
11/55/M COPD, cor pulmonale xs dose SR 49.1 Nausea, abdominal pain, nervousness, tremor, hypokalemia 36
12/79/M COPD, CHF, AF, digoxin xs dose SR 72.0 Nausea, vomiting, nervousness, tremor, hypokalemia 67
13/60/M COPD, angina xs dose SR 44.7 Nausea, vomiting, nervousness, tremor 37
14/63/M COPD, AF, digoxin, calcium antagonist xs dose IV 32.9 Nervousness, tremor 34
15/65/M COPD Took extra SR 33.8 Nausea, vomiting, nervousness, tremor 25
16/68/M COPD, calcium antagonist Took extra SR 59.3 Nausea, vomiting, hypokalemia 38

Table 2—Cardiac Rhythm Disturbances during Theophylline Toxicity

PatientNo. Sustained Sinus Tachycardia >150/min SVE Runs VPB/h VentricularCouplet/ll VentricularRun/li
1 + .357 <1 0
2 + <1 0 0
3 + + 327 13 <1
4 + 0 0 0
5 0 0 0
6 52 <1 0
7 + 6 <1 <1
8 <1 0 0
9 3 0 0
10 + 0 0 0
11 + +,\1AT 1 0 0
12 AF 1,280 124 75
13 192 2 0
14 7 <1 <1
15 6 0 0
16 6 0 0

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