The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Predictors of Major Toxicity after Theophylline Overdose

Michael Shannon, MD
[+] Article, Author, and Disclosure Information

From Children's Hospital, Harvard Medical School, and The Massachusetts Poison Control System, Boston, Massachusetts. Requests for Reprints: Michael Shannon, MD, MPH, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. Acknowledgments: The author thanks Dr. Frederick H. Lovejoy for assistance in manuscript preparation; Drs. Sam Lesko and Terry Fenton for assistance in statistical analyses; the poison specialists of the Massachusetts Poison Control System for their help in patient ascertainment; and Drs. Alan Woolf, Gary Fleisher, and Donald Goldmann for their helpful comments.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(12):1161-1167. doi:10.7326/0003-4819-119-12-199312150-00002
Text Size: A A A

Objective: To identify patients at high risk for major toxicity after theophylline intoxication who might benefit from early charcoal hemoperfusion.

Design: A 67-month prospective study.

Setting: Massachusetts Poison Control System.

Patients: 249 consecutive patients referred after theophylline intoxication (defined by a peak serum theophylline concentration 167 mol/L [30 mg/L]).

Interventions: Uniform, protocol-directed management recommendations.

Main Outcome Measures: Identification of risk factors for major toxicity.

Results: 119 patients (48%) not receiving theophylline therapy had acute intoxication; among those receiving such therapy, 92 (37%) had theophylline intoxication because of chronic overmedication and 38 (15%) had acute intoxication. Major toxicity developed in 62 patients (25%); 13 patients (5%) died. Major toxicity was more common in patients with intoxication due to chronic overmedication than in those with acute intoxication who were not receiving theophylline therapy (49% compared with 10%, risk ratio, 4.85; 95% CI, 2.96 to 7.94), even though the former group had lower peak serum theophylline concentrations [283 mol/L compared with 777 mol/L, P = 0.001]. Logistic regression analysis identified two major factors associated with the development of major toxicity: 1) peak serum theophylline concentrations in cases of acute intoxication and 2) patient age in cases of chronic overmedication. Receiver-operating characteristic curve analysis indicated that major toxicity occurred in patients with a peak serum theophylline concentration of greater than 555 mol/L (100 mg/L) after acute intoxication and in patients older than 60 years (regardless of peak serum theophylline concentration) after chronic overmedication.

Conclusions: Predictors for major toxicity after theophylline intoxication differ by type of overdose.


Grahic Jump Location
Figure 1.
Receiver-operator characteristic curve for patients with acute theophylline intoxication (top) and patients with intoxication due to chronic overmedication (bottom).

Curve shows the discriminant value of the peak serum theophylline concentration.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Receiver-operator characteristic curve for patients with intoxication due to chronic overmedication.

Curve shows the discriminant value of increasing chronologic age.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.