The document discusses two case studies involving theophylline intoxication. The first case involves a 25-year-old female who presented with vomiting and abdominal pain after ingesting 8 tablets of an asthma medication. Her vital signs were stable. The second case involves a 23-year-old female who presented in a coma after ingesting 25 tablets of an unknown drug at home, experiencing seizures and respiratory complications. Her vital signs were unstable. The document poses questions about diagnosing, treating complications, correcting blood gases, and prognosis in both acute theophylline intoxication and cases involving other drugs requiring urgent treatment.

1. By
Kerolus Ekram Gad Shehata
• PGY-III IM Resident, Ain Shams University
• ECFMG certified
Case studies on Theophylline
Intoxication

2. 25 YO F presented with repeated vomiting (15 times) and
abdominal pain 2 hours after taking 8 tablets of asthma drug
that is flat and dividable. She is A/O TPP with a clear chest
BP: 90/60, Pulse: 121, RR: 27
ABG: PH: 7.48, PCO2: 30, HCo3: 19
 What is your diagnosis?
 What is the first thing to do?
 How will you stop the vomiting?
 Will you still do induction of emesis or lavage?
 What is the role of AC?
 What if the patient started to get agitated ?
 What if the patient had a HX of seizures before coming to ER?
 Main factor determining prognosis in acute? GCS
 Main factor determining prognosis in acute on top of chronic?
Age and co-morbidities (cardiac, renal).

3. 23 YO F presented with HX of suicidal ingestion of 25 tablets of some
drug at home. 2 hours later she started vomiting, abdominal pain
about 26 times then she started convulsing 2 times and now presented
in a coma.
GCS: 8, Pupils: 2.5 mm B/L reactive, skin is cold, chest shows Rt. Sided
crepitations.
B.P: Can’t be detected, Pulse: Rapid and very faint. Apical pulse: 130.
RR: shallow and rapid 30
ABG: PH: 7.21, PCo2: 20, Hco3: 12, Sao2: 80%
 What will you do first?
 What is the complication that already happened here?
 Will you still do GI decontamination?
 How will you correct that ABG?
 Where will you refer it after stabilizing her vitals?
 Causes of death in this patient?
 What are the other drugs that need URGENT H.D?

4. Questions & Comments