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Theophylline toxicity — SCE Acute Medicine MCQ

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HardToxicology and OverdoseTheophylline toxicitySCE Acute Medicine

A 67-year-old man is assessed on the acute medical unit. He has COPD and presents with vomiting, tremor and supraventricular tachycardia after accidental excess theophylline. Potassium is 2.7 mmol/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Request urgent toxicology advice and cardiac monitoring

Request urgent toxicology advice and cardiac monitoring is the best answer because theophylline poisoning can cause refractory arrhythmias, seizures and hypokalaemia requiring specialist management. Perform synchronised direct-current cardioversion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Hypokalaemia in theophylline toxicity reflects intracellular shift rather than depletion alone.

Reference: Toxbase; BNF