Methylxanthines especially theophylline have been recognized as potent bronchodilators for of acute asthma over 65 years. Theophylline affects the cardiovascular (CV), neurological, gastrointestinal GI, and metabolic systems. One-hundred and ten patient's records with a discharge diagnosis of acute theophylline intoxication during the period from January 2007 to December 2008 at Poison control Center, Ain Shams University Hospitals were recruited. These patient's records were reported for history, clinical manifestations, investigations and management. It was noticeable that, majority of cases were Females between 10 to less than 30 years old. Gastrointestinal symptoms especially nausea and vomiting were the most frequent. Sinus tachycardia was present in (85.5%) of acute overdose cases, while hypotension was found in only one case. Agitation was present in (7.6%) of with single overdose, while (1.92%) of those cases presented with hallucination. Only one case with single overdose presented with seizures. All patients were having toxic serum theophylline levels and hypokalemia. This work concluded that agitation, sinus tachycardia and hypokalemia were considered as prognostic factors. Moreover, the recorded clinical and laboratory parameters categorized all patients in to mild, moderate and severe cases. In-addition, this study recommended that prognostic factors reported as well as grading system outlined in this work must be assessed routinely and as early as possible to evaluate and improve the outcome the case.