Navigating the storm: A case of severe theophylline toxicity and its management

Theophylline poisoning can lead to toxic effects on multiple organ systems. Management of theophylline overdose is focused on early detection, stabilizing cardiovascular and pulmonary function, GI decontamination to interrupt continued absorption, and minimizing end organ effects. We present a case of theophylline overdose with hemodynamic instability and metabolic derangements and review the literature to update the management of theophylline toxicity. An 80 year old Indian gentleman presented with dizziness and vomiting after deliberate ingestion of 20 tablets of theophylline. He was resuscitated successfully, and subsequently given supportive care. Serum theophylline levels were estimated to confirm theophylline toxicity. Diagnosis of theophylline poisoning requires high degree of suspicion and needs prompt and appropriate treatment. Initial treatment consists of fluid resuscitation, correction of electrolyte abnormalities and hyperglycemia. Supportive treatment plays a key role. Multidose activated charcoal for elimination of drug should be administered in severe theophylline poisoning. • Multisystem Effects of Theophylline Toxicity: It can cause critical cardiovascular, neurologic, and metabolic abnormalities that require rapid intervention. • Case of Deliberate Overdose in an Elderly Patient: An 80-year-old man who ingested a large dose of theophylline, resulting in acute toxicity. • Treatment Using Multidose Activated Charcoal (MDAC): MDAC was effectively used to enhance elimination, supported by antiemetic and fluid therapy, and close electrolyte monitoring. • Management of Hemodynamic Instability: Prompt IV fluid resuscitation stabilized blood pressure and controlled heart rate in the setting of beta-adrenergic excess. • Critical Role for Emergency Physicians: Recognizing and managing theophylline toxicity remains essential in emergency settings, particularly in regions where it is still widely used for COPD.