Description

A late middle-aged woman was admitted to hospital having taken 10g of theophylline in an impulsive overdose. Soon after her arrival in the Casualty department her conscious level deteriorated and she developed a supraventricular tachycardia and hypotension. The development of status epilepticus then necessitated intubation and ventilation on the intensive care unit (ICU). Initial serum biochemistry revealed hypokalaemia, otherwise normal electrolytes and a peak theophylline level of 1520 umol l-1. Charcoal haemofiltration was commenced, rapidly reducing her theophylline levels and 72 hours post-ingestion the patient was successfully weaned from the ventilator. Unfortunately, on day 4 post-overdose, despite being haemodynamically stable, the patient became rapidly oliguric, fluid overloaded and hyperkalaemic prompting transfer to the regional renal unit for further assessment and treatment.

Examination on arrival at the renal unit revealed a flushed, tachypnoeic patient with hyperdynamic circulation, an elevated central venous pressure, signs of a possible left mid-zone consolidation and a generally tender distended abdomen. She had severe pain in her legs and right forearm with associated distal parasthesiae and fixed plantar flexion of both feet. Peripheral pulses were present but the anterior compartments of both legs and also the right forearm were acutely tender and markedly swollen with profound functional loss. Serum creatinine on arrival was 229 umol l-1 with a CPK of 81,000 umol l-1, aspartate transaminase of almost 3000 umol l-1 and a theophylline level of <0.1 umol l-1.