Vasopressor-resistant hypotension following a massive ingestion of theophylline

OBJECTIVE: To report the unusual and poorly understood occurrence of vasopressor-resistant hypotension following a suicidal ingestion of theophylline. DESIGN: Single case report. SETTING: Eight-bed, respiratory intensive care unit in a 937-bed teaching hospital. PATIENT: A 52-year-old man with a past medical history significant only for hypertension. RESULTS: The additive influence of markedly elevated theophylline serum concentrations, status epilepticus, and vasopressor-resistant hypotension was associated with the patient's death. Intravenous dosages of epinephrine, norepinephrine, and phenylephrine (ranges 160-210, 32-105, and 200-250 micrograms/min, respectively) were ineffective in controlling the patient's dramatic hypotension. CONCLUSIONS: In addition to the usual metabolic abnormalities and central nervous system effects seen in theophylline poisoning, severe hypotension can occur and prove resistant to commonly used vasopressors. Early identification and treatment of theophylline poisoning is warranted to prevent the development of severe sequelae.