Theophylline induced seizure

Q: Paramedics have been called at home by the family for a 32-year-old asthmatic patient who is suspected to have Theophylline toxicity. Para-medics intubated the patient and administrated repeated doses of Lorazepam in the ambulance. In the ER patient is still noted to have bouts of seizure. Keppra was administrated without any effect. What should be the next drug of choice in this probable Theophylline-induced seizure?

A) Phenytoin

B) Phosphenytoin

C) Carbamazepine

D) Phenobarbital

Answer: D

The objective of this question is to emphasize that Phenytoin is usually not effective in Theophylline-induced seizure. Lorazepam or Diazepam (benzodiazepines) are the first line of drugs. If the seizure continues, phenobarbital is indicated. One of the other advantages of Phenobarbital is that it enhances the hepatic metabolism of theophylline.

In case of phenobarbital failure, general anesthesia is indicated. Hemodialysis should be strongly considered along with treatment for the seizure.

#neurology

#toxicity

References:

1. Journey JD, Bentley TP. Theophylline Toxicity. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532962/

2. Gitomer JJ, Khan AM, Ferris ME. Treatment of severe theophylline toxicity with hemodialysis in a preterm neonate. Pediatr Nephrol. 2001 Oct;16(10):784-6. doi: 10.1007/s004670100650. PMID: 11605782.