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General Recommendation

  • ECTR is recommended in severe theophylline poisoning (1C)



ECTR is recommended if ANY of the following conditions are present:

  • [Theophylline] > 100 mg/L (555 µmol/L) in acute exposure (1C)

  • Seizures are present (1D)

  • Life-threatening dysrhythmias are present (1D)

  • Shock is present (1D)

  • There is a rising serum [theophylline] despite optimal therapy (1D)

  • There is clinical deterioration despite optimal therapy (1D)


ECTR is suggested if:

  • [Theophylline] > 60 mg/L (333 µmol/L) in chronic exposure (2D)

  • The patient is < 6 months or > 60 years old and the [theophylline] > 50 mg/L (278 µmol/L) in chronic exposure (2D)

  • Gastrointestinal decontamination cannot be administered (2D)


Cessation of ECTR:

  • Cessation of ECTR is recommended when clinical improvement is apparent OR the [theophylline] 15 mg/L (83 µmol/L) (1D)


Choice of ECTR:

  • Intermittent hemodialysis is the preferred recommended ECTR (1C)


The following are acceptable alternatives if hemodialysis is not available:

  • Hemoperfusion (1C)

  • CRRT (3D)

  • Exchange transfusion is an alternative to hemodialysis in neonates (2D)



  • MDAC should be continued during ECTR (1D)



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