Theophylline remains the most widely pharmaceuticals for the treatment of acute and chronic asthma in several developing countries, as it is effective, cheap, and widely available. Few   studies   were  investigated  to  predict  the  need  of  ICU admission based  on  clinical  parameters  recorded   at  admission. Hence, this study aimed to identify the predictors for ICU admission in acute theophylline intoxicated patients.  It was carried out on one hundred and ten acutely theophylline poisoned patients who were admitted to Poison Control Unit, Emergency Hospital, Tanta University over a period of two years. For each patient, full sociodemographic, toxicological, clinical examination and routine laboratory investigations & serum theophylline level were done. Then, all findings of acute theophylline poisoned patients were analyzed against ICU admission. Statistical significant associations were found between ICU admission and gender, dose, CNS manifestations (agitations, hallucinations and tremors), hypotension, serum potassium and serum theophylline level. Logistic regression of clinically relevant variable showed that, patients who presented with hallucination, agitation, or hypotension had an increased likelihood of requiring admission to ICU and could correctly predicted 98.2% of cases. ROC curve analysis of serum theophylline accuracy revealed that, serum level ≥ 37.5 mg/L is a fair predictor for ICU admission. It could be concluded that, in acute theophylline intoxicated patients, hallucination, agitation and hypotension could be considered as good predictors for ICU admission. While, patients who had serum theophylline level ≥ 37.5 mg/L should be admitted in ICU as high risk patients.