Clinical Spectrum, ECG Findings, and Outcomes of Aminophylline Toxicity in a Tertiary Care Hospital

Abstract

Background: Aminophylline is a bronchodilator with a narrow therapeutic range and a risk of toxicity, which may cause gastrointestinal, neurological, and cardiovascular complications.

Objective To determine the clinical spectrum, ECG findings, and outcomes of aminophylline toxicity in patients admitted to a tertiary care hospital in Peshawar.

Methodology: A retrospective observational study was conducted from May 2024 to November 2024 among patients with documented aminophylline exposure and features of toxicity. Data regarding demographics, clinical manifestations, aminophylline use, ECG findings, comorbidities, management, and outcomes were collected from medical records. Descriptive statistics, Chi-square tests, and analysis of potential confounding variables were performed. A p-value <0.05 was considered statistically significant.

Results: A total of 246 patients were included, with 126(51.2%) males and 120(48.8%) females. The mean age was 53.41±15.21 years. COPD exacerbation was present in 159(64.6%) patients and asthma exacerbation in 87(35.4%) patients. Mild, moderate, and severe toxicity occurred in 144(58.5%), 77(31.3%), and 25(10.2%) patients, respectively. Sinus tachycardia was the most frequent ECG abnormality, observed in 132(53.7%) patients, while normal sinus rhythm was recorded in 114(46.3%) patients. ICU admission occurred in 32(13.0%) patients and mortality in 1(0.4%) patient. Toxicity severity was significantly associated with ICU admission (χ²=186.130, p<0.001), and sinus tachycardia was also associated with ICU admission (χ²=12.570, p<0.001). COPD (p=0.471), chronic kidney disease (p=1.000), drug interaction risk (p=0.154), and polypharmacy (p=0.657) were not significant confounders.

Conclusion: Aminophylline toxicity presents with diverse clinical features, and ECG abnormalities, particularly sinus tachycardia, may indicate the need for closer monitoring. Early recognition of toxicity severity and appropriate management may improve outcomes in patients receiving aminophylline.

Keywords: Aminophylline; Drug Toxicity; Electrocardiography; Bronchodilator Agents; Adverse Drug Reaction