Indications of Williams and Erickson for Hemodialysis or Hemoperfusion in a Patient with Theophylline Intoxication

A patient with a life-threatening exposure to theophylline may require aggressive detoxification.

Molecular weight of theophylline: 180.17 g

Patient selection: elevated serum theophylline concentration (therapeutic range 10-20 µg/mL)

Parameters:

(1) temporal nature of the exposure

(2) serum theophylline concentration

(3) clinical signs and symptoms

Exposure	Serum Concentration	Clinical Signs and Symptoms	Treat?
acute	> 100 µg/mL	NA	Yes
chronic	> 60 µg/mL	NA	Yes
4 hours after dose of sustained-release formulation	> 70 µg/mL	NA	Yes
NA	> 40 µg/mL	present	Yes
NA	> 40 µg/mL and rising despite therapy	NA	Yes

Significant signs and symptoms may include:

(1) hypotension

(2) seizures

(3) ventricular arrhythmias

Aggressive detoxification may take the form of:

(1) hemodialysis

(2) charcoal hemoperfusion

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