Severe hypokalemia and status epilepticus associated with theophylline toxicity

Theophyllinecan induce severe metabolic complications, including hypokalemia, seizure and cardiac arrhythmias. However, clinicians can fail to identify this drug as the cause of these complications. We describe here a case for which the patient's theophyllinetoxicity went unrecognized over a period of several days after the complications developed. An 84-year-old man who was without any previous history of seizure was admitted to our hospital because of two episodes of generalized tonic-clonic seizure. His initial potassium level was 1.64 mmol/L. The electroencephalogram showed frequent, single or sequential, sharp and slow waves of high amplitudes on the right fronto-polar area, which was compatible with focal seizure. With giving only 100 mmol of K + replacement over the three days, the serum potassium level increased to 3.5 mmol/L. His generalized tonic clonic seizurewas controlled by lorazepamand phenytoin. We obtained the history of theophyllinemedication from his son on the 5 th hospital day. At that time, the serum theophyllinelevel was 9.18 ug/mL.(Korean J Med 73:S1008-S1011, 2007)