A case of severe theophylline overdose is described in which clinical signs of toxicity initially were minimal despite extremely high serum drug levels. Hemodialysis was performed because of the risk of seizures and cardiac arrhythmias. The predialysis, dialysis, and postdialysis half-lives were 13.1, 4.3, and 6.7 hours, respectively. Corresponding total body clearance values were 23.8, 72.5, and 46.3 ml/kg/h. The patient showed apparent saturation kinetics of theophylline clearance at high serum levels. Hemodialysis is effective for enhancing the removal of theophylline.
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