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SAH rule-out — MCCQE Part 1 MCQ

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ModerateHeadacheSAH rule-outMCCQE Part 1

A patient with a sustained-release theophylline overdose has recurrent seizures, ventricular dysrhythmias, hypotension and severe hypokalemia despite initial supportive care. What is the best next intervention?

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Correct answer: D — Arrange urgent intermittent hemodialysis

Recurrent seizures, ventricular dysrhythmias and shock are life-threatening manifestations of theophylline poisoning and are indications for urgent extracorporeal treatment regardless of delay in obtaining another concentration. Intermittent hemodialysis is preferred because it rapidly clears theophylline while correcting electrolyte and acid-base abnormalities. Continue airway and cardiovascular support, benzodiazepine seizure treatment, aggressive potassium monitoring and poison-centre management; repeated-dose activated charcoal may enhance elimination when the airway is protected and ileus is absent. Potassium replacement alone does not treat the ongoing toxin burden, and waiting risks refractory dysrhythmia and status epilepticus.

Reference: EXTRIP—Theophylline: https://www.extrip-workgroup.org/theophylline