Theophylline or Physician Toxicity?
Authors: Michael J. Henry
Journal: Annals of Internal Medicine (1991)

Letters1 September 1991Theophylline or Physician Toxicity?Michael J. Henry, MDMichael J. Henry, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-5-407 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors:Schiff and colleagues' report (1) on preventable factors in inpatient theophylline toxicity documents the many circumstances that may contribute to the development of theophylline toxicity. Also documented are the negligence or incompetence of the responsible physicians at Cook County Hospital. Being a "busy physician" is no excuse for 1) ordering a drug level but failing to check the result; 2) failing to consider factors predisposing to theophylline toxicity (for example, heart failure, liver disease, or coadministration of drugs known to decrease theophylline clearance) when determining dosage; 3) failing to consider drug toxicity in a patient developing psychosis...References1. SchiffHegdeLaClocheHryhorczuk GHLD. Inpatient theophylline toxicity: preventable factors. Ann Intern Med. 1991;114:748-53. LinkGoogle Scholar2. Kotulak R. County Hospital care rates with the best, report says. Chicago Tribune. 1986;16 March:1. Google Scholar1. SchiffHegdeLaClocheHryhorczuk GHLD. Inpatient theophylline toxicity: preventable factors. Ann Intern Med. 1991;114:748-53. LinkGoogle Scholar2. RossingFantaGoldstein TCD. Emergency therapy of asthma: comparison of the acute effects of parenteral and inhaled sympathomimetics and infused aminophylline. Am Rev Respir Dis. 1980;122:365-71. MedlineGoogle Scholar3. SiegelSheppardGelbWeinberg DDAP. Aminophylline increases the toxicity but not the efficacy of an inhaled beta-agonist in the treatment of acute exacerbations of asthma. Am Rev Respir Dis. 1985;132:283-6. MedlineGoogle Scholar4. KellyMurphy HS. Should we stop using theophylline for the treatment of the hospitalized patient with status asthmaticus? Drug Intell Clin Pharm. 1989;23:995-8. Google Scholar5. . Guidelines for the diagnosis and management of asthma. Bethesda, Maryland: National Heart, Lung and Blood Institute Information Center; 1991. Google Scholar1. DuboisBrook RR. Preventable deaths: who, how often, and why? Ann Intern Med. 1988;109:582-9. LinkGoogle Scholar2. BrennanLeapeLaird TLN. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Malpractice Study I. N Engl J Med. 1991;324:370-6. CrossrefMedlineGoogle Scholar3. BedellDeitzLeemanDelbanco SDDT. Incidence and characteristics of preventable iatrogenic cardiac arrests. JAMA. 1991;265:2815. CrossrefMedlineGoogle Scholar4. GageWeslowskiAndrulis LVD. America's safety net hospitals: the foundation of our nation's health system. Washington, D.C.: National Association of Public Hospitals; 1991. Google Scholar5. SullivanWilensky LG. Medicare hospital mortality information, 1987, 1988, 1989: vol. 10. Washington, DC: Health Care Financing Administration; 1991; HCFA publication no. 00729. Google Scholar1. SchiffHegdeLaClocheHryhorczuk GHLD. Inpatient theophylline toxicity: preventable factors. Ann Intern Med. 1991;114:748-53. LinkGoogle Scholar2. SelfAbou-ShalaBurns TNR. Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics: does aminophylline add any benefit? Chest. 1990;98:1317-21. CrossrefMedlineGoogle Scholar3. StraussBonaguraSchuvalValacer RVSD. Effects of aminophylline on status asthmaticus in children. J Allergy Clin Immunol. 1991;87:309. CrossrefGoogle Scholar4. Barnes P. A new approach to the treatment of asthma. N Engl J Med. 1989;321:1517-27. CrossrefMedlineGoogle Scholar5. LamNewhouse AM. Management of asthma and chronic airflow limitations: are methylxanthines obsolete? Chest. 1990;98:44-52. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cook County Hospital Chicago, IL 60612 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1991Volume 115, Issue 5Page: 407-408KeywordsAdverse reactionsHeart failureInpatientsLiver diseasesPsychosesTheophylline toxicityToxicity Issue Published: 1 September 1991 PDF DownloadLoading ...