Document Detail


Comparative efficacy of hemodialysis and hemoperfusion in severe theophylline intoxication.
MedLine Citation:
PMID:  9223689     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  4     ISSN:  1069-6563     ISO Abbreviation:  Acad Emerg Med     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-09-15     Completed Date:  1997-09-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  674-8     Citation Subset:  IM    
Affiliation:
Children's Hospital, Department of Pediatrics, Boston, MA 02115. shannon@al.tch.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Bronchodilator Agents / poisoning*
Chi-Square Distribution
Child
Child, Preschool
Chronic Disease
Female
Hemoperfusion* / adverse effects,  mortality
Humans
Infant
Male
Massachusetts / epidemiology
Middle Aged
Overdose
Poisoning / classification,  therapy
Prospective Studies
Renal Dialysis* / adverse effects,  mortality
Risk
Theophylline / poisoning*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 58-55-9/Theophylline

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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