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You are here: Home / 14. Toxicology / Methylxanthines

Methylxanthines

July 14, 2011 by CrashMaster

(Theophylline and Caffeine)

All are structurally similar to adenosine.  They exert their effects by competitively inhibiting adenosine binding in the CNS where adenosine would allow increased GABA channel flow and peripherally where adenosine is a vasodilator.  At high doses, they may act as a phosphodiesterase inhibitor

Theophylline levels will increase with smoking cessation.

 

Caffeine overdoses are often from OTC alertness meds (NoDoz) and migraine meds

Therapeutic levels of caffeine and theophylline are 5 to 15 ug/ml

>20 is toxic range in patients without prior exposure

Presents with abdominal pain and n/v with any significant dose

sinus tachycardia or MAT, can progress to AMI or v. tach

vasodilation

agitation, nervousness, headache, seizures

hypokalemia and hyperglycemia

hyperthermia

Widened pulse pressure, vasodilation leads to decreased diastolic, inotropy leads to increased systolic

 

Theophylline levels Q2

Lavage if sustained release

AC for immediate absorption and gut dialysis.  1-2 grams/kg Q2 hrs to 7 doses

Consider whole bowel irrigation along with charcoal

Fluids

For SVT diltiazem or esmolol

Phenylephrine or Norepi

Vent dysrhythmias give lidocaine and consider b-blockade

Seizures-benzos

Consider Charcoal Hemoperfusion/HD if

Theo level >40 with seizures, hypotension, vent dysrhythmias, or protracted vomiting

Theo level >90 acute or >60 chronic

 

Of note, adenosine will not work with theo on board, probably won’t work with a few cups of coffee on board either

 

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Filed Under: 14. Toxicology


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