Early Cessation of Renal Replacement Therapy in Theophylline Toxicity: A Case Report With Literature Review

Theophylline toxicity often results in severe neurological and cardiovascular complications and may require renal replacement therapy (RRT) in life-threatening situations. However, guidance on when it is safe to discontinue RRT remains limited. We report the case of an 85-year-old woman who developed status epilepticus following theophylline overdose, with a peak serum level of 119.8 mg/L. She was initially hemodynamically unstable and received continuous hemodiafiltration (CHDF). After clinical stabilization and a reduction in serum theophylline to 24.7 mg/L, CHDF was discontinued despite mild tachycardia and low-dose catecholamine use. The patient remained stable without rebound toxicity and recovered uneventfully. This case highlights that early discontinuation of RRT may be feasible even when theophylline levels exceed traditional thresholds, provided there is sustained clinical improvement, including stability despite mild tachycardia and low-dose catecholamine support.