Chloroquine poisoning

Substance

Chloroquine

Common name or Trade name, used in

-          Chloroquine is a derivative of 4-aminoquinoline [1]

-          toxic dose > 20mg/kg [2]

-          fatal when > 5 gm [3]

-          Used in the malaria prophylaxis [1]

-          treatment of malaria, some connective tissue diseases, COVID-19 infection [1, 4]

 

Involving system

-          cardiovascular system [2].

-          altered mental status [2]

-          apnea, hyperventilation [2]

-          quinidine-like action [2].

-          negative inotropic action [2]

 

Presentation

-          Seizure [1]

-          Ventricular fibrillation [1]

-          QRS widening [5]

-          QTc prolongation [1]

-          Shock [5]

-          Cardiovascular collapse. [5] OHCA (15%) [6]

Antidote and Treatment

-          IVF + adrenalin, ACLS [5, 7]

-          NaHCO3 –

-          mechanical ventilation if respiratory failure [5, 7].

-          intravenous administration of diazepam and epinephrine [5]

-          diazepam dose (1 mg/kg) [7, 8] stat and 5—10mg/hrs. * 48 hours. Mechanism: increased chloroquine concentration in the blood, but decreased it in the heart muscle [2].

-          ECMO [5]

Disposition

-          MICU if hemodynamic change/ AMS [5]

-          overall mortality for all degrees of intoxication: 8.4% to 10% [6, 7]. 

References

 

[1] Ciszowski K, Winnik L, Groszek B, Kłys M, Kołodziej J. Ostre zatrucie chlorochina--rzadkie, ale zawsze powazne: opis przypadków i przeglad literatury [Acute chloroquine intoxication--rare, but always serious: case reports and literature review]. Przegl Lek. 2005;62(6):501–507.

[2]. Rajah A. The use of diazepam in chloroquine poisoning. Anaesthesia. 1990;45(11):955–957. doi:10.1111/j.1365-2044.1990.tb14629.x

[3] Riou B, Barriot P, Rimailho A, Baud FJ. Treatment of severe chloroquine poisoning. N Engl J Med. 1988;318(1):1–6. doi:10.1056/NEJM198801073180101

[4] Hu TY, Frieman M, Wolfram J. Insights from nanomedicine into chloroquine efficacy against COVID-19 [published online ahead of print, 2020 Mar 23]. Nat Nanotechnol. 2020;10.1038/s41565-020-0674-9. doi:10.1038/s41565-020-0674-9

[5] Bagate F, Radu C, Mekontso Dessap A, de Prost N. Early extracorporeal membrane oxygenation for cardiovascular failure in a patient with massive chloroquine poisoning. Am J Emerg Med. 2017;35(2):. doi: 10.1016/j.ajem.2016.08.058

[6] Clemessy JL, Taboulet P, Hoffman JR, et al. Treatment of acute chloroquine poisoning: a 5-year experience. Crit Care Med. 1996;24(7):1189–1195. doi:10.1097/00003246-199607000-00021

[7] Clemessy JL, Lapostolle F, Borron SW, Baud FJ. Intoxication aiguë à la chloroquine [Acute chloroquine poisoning]. Presse Med. 1996;25(31):1435–1439.

[8]. Altrock G, Lange A, Münster P. Akute Chloroquin-Intoxikation [Acute chloroquine poisoning]. Dtsch Med Wochenschr. 1997;122(8):225–228. doi:10.1055/s-2008-1047601

 

-- 26th March, 2020  Yu-Jang Su