Hemoperfusion/hemodialysis in the treatment of acute theophylline poisoning--description of a fatal case.

Treatment of theophylline overdosage with hemodialysis and/or hemoperfusion is accepted as necessary in the most severe cases. We treated a 63 year-old woman who had an initial theophylline concentration of 1000 micromol/l with resin hemoperfusion (Extracorporeal XAD-4). The theophylline concentration before and after the filter was found to approach each other in a linear pattern, and it was possible to predict the time of saturation of the filter. This happened after 2 hours and the treatment was then changed to hemodialysis and charcoal hemoperfusion in series. This combination was highly efficient in removing theophylline and no saturation occurred during the rest of the treatment. Theophylline clearance fell from 200 ml/min to 28 ml/min in 2 hours using resin hemoperfusion and from 196 ml/min to 177 ml/min using the combination of dialysis and charcoal hemoperfusion. Despite this theoretical successful treatment, the patient died 24 hours later.