RESUMO
Se estudian las complicaciones del uso de la tiofilina en la bronquitis aguda, cuyo uso, además de controversial, no parece beneficiar. Una muestra de 10 lactantes menores de 12 meses (X=38) de edad, 5 varones y 5 hembras que ingresaron a la Unidad de Terapia Intensiva Infantil, del hospital "Miguel Pérez Carreño" de Cararas, lapso de un año, con diagnóstico de bronquitis aguda asociada a intoxicación por Teofilina recibida vía intravenosa, en dosis de 3 a 6 mg/Kg/dosis cada 6 horas. Todos presentaron taquicardia entre 170 y 230 latidos/min (X=190), taquipnea entre 40 y 80 respiraciones/min (X=73), agitación psicomotora, anemia y deshidratación. 5 presentaron vómitos y convulsiones. A todos se les determinaron niveles séricos de teofilina, siendo el promedio al ingreso de 34,8 microgr/ml. Cinco pacientes ameritaron ventilación mecánica, 4 por empeoramiento de la dificultad respiratoria y uno por acidosis respiratoria severa. El tratamiento consistió en omitir la teofilina, expandir con solución al 0.9 por ciento de NaCl a dosis de 10 ml/Kg/STAT, hidratación de mantenimiento, concentrado de glóbulos rojos y oxigeno humedo. Todos respondieron satisfactoriamente. El tiempo promedio de hospitalización fué de 6,2 días en el grupo con ventilación mecánica y de 2,4 días en el grupo que no la ameritó. Se concluye que la teofilina en la bronquiolitis aguda no mejora la evolución de la enfermedad más bién puede empeorarla
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Bronquiolite/classificação , Bronquiolite/diagnóstico , Bronquiolite/terapia , Teofilina/intoxicaçãoAssuntos
Transfusão Total , Teofilina/intoxicação , Overdose de Drogas/terapia , Feminino , Humanos , LactenteRESUMO
OBJECTIVES: To determine whether the method of intoxication influences the metabolic disturbances and pattern of life-threatening events that occur after theophylline intoxication in children. METHODS: Five-year prospective observational study of consecutive pediatric patients referred to a regional poison control center with a theophylline concentration (theo) greater than or equal to 30 micrograms/ml. At the time of referral, intoxication was categorized as acute (single toxic exposure), chronic (long-term toxic exposure), or acute-on-therapeutic (single toxic exposure superimposed on maintenance therapy). RESULTS: One-hundred twenty-five patients were monitored. Mean age was 12 years (range, 3 days to 20 y). Seventy-four patients (59%) had acute intoxication, 31 (25%) had chronic intoxication, and 20 (16%) had acute-on-therapeutic intoxication. Mean peak serum (theo) was 55 micrograms/ml. Life-threatening events occurred in 12 patients (10%). Patients with acute intoxication had a significantly lower serum potassium level (3.04 vs 3.80 mmol/L; p less than 0.001) and higher serum glucose level (10.8 vs 7.0 mmol/L (194 vs 127 mg/dl); p less than 0.001) than did children with chronic intoxication. Although life-threatening events (seizures or arrhythmias) occurred at a similar rate across categories, the (theo) at which these events occurred was significantly higher in patients with acute intoxication than in those with chronic intoxication (100 vs 42 micrograms/ml; p = 0.02). Among children with chronic intoxication, those who had life-threatening events had (theo) similar to those who remained well (42 vs 47 micrograms/ml) but were significantly younger (1.6 vs 8.0 years; p less than 0.001). CONCLUSIONS: These data indicate that method of intoxication has significant effects on the metabolic and clinical consequences of theophylline poisoning. Life-threatening events occur in those with acute theophylline intoxication at significantly higher (theo) than in those with chronic intoxication. After chronic intoxication, peak (theo) does not identify patients at risk for life-threatening events; young age appears to be the primary risk factor. These findings potentially complicate the management of theophylline poisoning, given the difficulty of extracorporeal drug removal in young infants.
Assuntos
Teofilina/intoxicação , Doença Aguda , Adolescente , Adulto , Fatores Etários , Arritmias Cardíacas/induzido quimicamente , Bicarbonatos/sangue , Criança , Pré-Escolar , Doença Crônica , Humanos , Hiperglicemia/induzido quimicamente , Hipopotassemia/induzido quimicamente , Lactente , Recém-Nascido , Erros de Medicação , Estudos Prospectivos , Fatores de Risco , Convulsões/induzido quimicamente , Teofilina/administração & dosagem , Teofilina/sangue , Teofilina/metabolismoRESUMO
Sixty-five cases of theophylline toxicity in children were reviewed. Vomiting, tachycardia, and central nervous system excitation were the most common manifestations. Seizure activity occurred in four acutely intoxicated children whose serum theophylline concentrations were less than 70 micrograms/ml. Two patients experienced visual hallucinations in association with high serum theophylline levels. Dosing errors accounted for the majority of cases. Most instances of toxicity could have been avoided by more careful consideration of the patient's medication history and more diligent monitoring of serum theophylline concentrations.
Assuntos
Teofilina/intoxicação , Abdome , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Dor/induzido quimicamente , Convulsões/induzido quimicamente , Taquicardia/induzido quimicamente , Teofilina/administração & dosagem , Teofilina/sangue , Tremor/induzido quimicamente , Vômito/induzido quimicamenteAssuntos
Carvão Vegetal/uso terapêutico , Teofilina/intoxicação , Criança , Pré-Escolar , Humanos , Lactente , Recém-NascidoAssuntos
Arritmias Cardíacas/induzido quimicamente , Convulsões/induzido quimicamente , Teofilina/intoxicação , Vômito/induzido quimicamente , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Absorção Intestinal , Masculino , Tentativa de Suicídio , Teofilina/metabolismoRESUMO
Three cases of theophylline poisoning in young children, two of which occurred after erroneous administration of commonly prescribed pediatric drugs, are presented. The possible association of hyperglycemia and ketoacidosis with severe theophylline toxicity is discussed. Serial serum theophylline levels and half-life determinations for two patients suggest that, although serum half-lives (8.5 hours and 9.0 hours) may be slightly longer than average, drug disappearance followed first order kinetics even at extremely high erum theophylline levels.