Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication.

Abstract

OBJECTIVE:

To determine the comparative efficacy of hemoperfusion and hemodialysis for severe theophylline toxicity in concurrent case series.

METHODS:

A 10-year, prospective, observational study was performed of consecutive patients referred to a regional poison control center with severe theophylline intoxication in whom either hemodialysis or hemoperfusion was used. The primary outcomes were 1) incidence of major theophylline toxicity (convulsions or life-threatening cardiac dysrhythmias) during or after each procedure, 2) calculated theophylline clearance, and 3) procedure-related complications.

RESULTS:

Over the study period, 56 patients underwent hemodialysis or hemoperfusion as treatment of severe theophylline intoxication. Overall mean age was 40.5 +/- 22.9 years. Mean peak serum theophylline concentration was 103.3 +/- 39.1 micrograms/mL (range 36 to 245 micrograms/mL). Thirty patients (54%) were victims of acute theophylline intoxication, while 18 (32%) had chronic overmedication and 8 (14%) had acute-on-therapeutic intoxication. Thirty-nine patients (70%) underwent hemodialysis, while 17 (30%) underwent hemoperfusion. There were no significant intergroup differences in age (39.4 vs 43.0 yr), peak serum theophylline concentration (99.5 vs 112.1 micrograms/mL), time to procedure (8.4 vs 6.3 hr), or duration of procedure (4.1 vs 3.7 hr). Thirty-three percent of the patients undergoing hemodialysis had major toxicity during or after the procedure, compared with 18% of those who received hemoperfusion (p = NS). Post-procedure serum theophylline concentrations were 26.9 vs 30.4 micrograms/mL, corresponding to drug clearance rates of 185.1 and 294.8 mL/kg/hr (p = 0.03). Procedural complications occurred in 3 patients who received hemoperfusion and consisted of bleeding diatheses and hypocalcemia. No complications occurred in patients receiving hemodialysis (p = 0.007).

CONCLUSIONS:

These data confirm that hemoperfusion provides a higher theophylline clearance rate than hemodialysis. However, hemodialysis appears to have comparable efficacy in reducing the morbidity of severe theophylline intoxication and is associated with a lower rate of procedural complications.

• Authors: M W Shannon
• Journal: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (Acad Emerg Med) Vol. 4 Issue 7 Pg. 674-8 (Jul 1997) ISSN: 1069-6563 [Print] United States
• PMID: 9223689 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Bronchodilator Agents
• Theophylline

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bronchodilator Agents (poisoning)
• Chi-Square Distribution
• Child
• Child, Preschool
• Chronic Disease
• Drug Overdose
• Female
• Hemoperfusion (adverse effects, mortality)
• Humans
• Infant
• Male
• Massachusetts (epidemiology)
• Middle Aged
• Poisoning (classification, therapy)
• Prospective Studies
• Renal Dialysis (adverse effects, mortality)
• Risk
• Theophylline (poisoning)
• Treatment Outcome