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hydroxychloroquine overdose

Peter B Chansky, Victoria P Werth
Hydroxychloroquine is an oral antimalarial medication commonly used off-label for a variety of rheumatological conditions, including systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome and dermatomyositis. We present a case of a 64-year-old woman who presented with acute onset headache, bilateral tinnitus, and left-sided facial numbness and tingling in the setting of accidentally overdosing on hydroxychloroquine. By the next morning, the patient began to experience worsening in the tingling sensation and it eventually spread to her left arm, thigh and distal extremities...
April 12, 2017: BMJ Case Reports
Paul B McBeth, Perseus I Missirlis, Harry Brar, Vinay Dhingra
Introduction. Hydroxychloroquine (HCQ) overdose is rare and potentially deadly when consumed in large doses. Management of severe HCQ toxicity is limited and infrequently reported. This report presents the case of a massive ingestion of HCQ. Case Report. A 23-year-old female presents following an intentional ingestion of approximately 40 g of HCQ. Within six hours after ingestion, she developed severe hemodynamic instability resulting from myocardial irritability with frequent ventricular ectopic activity leading to runs of polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) requiring multiple defibrillations...
2015: Case Reports in Emergency Medicine
David J Browning, Chong Lee
BACKGROUND: The purpose of this study was to determine the relative sensitivity and specificity of 10-2 visual fields (10-2 VFs), multifocal electroretinography (mfERG), and spectral domain optical coherence tomography (SD-OCT) in detecting hydroxychloroquine retinopathy. METHODS: A total of 121 patients taking hydroxychloroquine (n=119) or chloroquine (n=2) with 10-2 VF, mfERG, and SD-OCT tests were retrospectively reviewed. Rates of test abnormality were determined...
2014: Clinical Ophthalmology
Lucía Martínez-Costa, María Victoria Ibañez, Cinta Murcia-Bello, Irene Epifanio, Cristina Verdejo-Gimeno, Emma Beltrán-Catalán, Pilar Marco-Ventura
OBJECTIVE: To check the ability of microperimetry to detect early retinal damage in patients with rheumatism taking hydroxychloroquine (HCQ), chloroquine (CQ), or both, and to describe the microperimetric alterations attributable to these drugs and their correlation with some clinical variables. DESIGN: Controlled cross-sectional study. PARTICIPANTS: Patient group was 209 patients taking HCQ or CQ. Control group was 204 individuals not taking antimalarials...
October 2013: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Sevil Ari Yaylali, Fariz Sadigov, Hasan Erbil, Asiye Ekinci, Aylin Ardagil Akcakaya
To evaluate the role of previously reported risk factors on developing retinopathy in patients treated with chloroquine (CQ) and hydroxychloroquine (HCQ). Ophthalmologic examination, visual field testing, and spectral domain-optical coherence tomography were performed in 31 patients treated with CQ and HCQ. Toxicity diagnosis was proven by electrophysiological assessment. The risk factors reported by the American Academy of the Ophthalmology (AAO) were compared between patients with (n = 5) and without toxicity (n = 26) findings...
December 2013: International Ophthalmology
Michael F Marmor
OBJECTIVES: To compare different screening procedures for hydroxychloroquine sulfate (Plaquenil) toxicity at different stages of damage. METHODS: Ten patients were studied using 10-2 automated fields, multifocal electroretinography, spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence. RESULTS: All 10 patients used hydroxychloroquine for more than 6 years, and those with severe toxicity had been overdosed. Fundus examination findings were normal except for the patients with severe toxicity...
April 2012: Archives of Ophthalmology
N Gunja, D Roberts, D McCoubrie, P Lamberth, A Jan, D C Simes, P Hackett, N A Buckley
Hydroxychloroquine overdose is infrequently reported and the majority of recommendations come from the greater experience with chloroquine poisoning. We report two cases of massive hydroxychloroquine poisoning (20 g in each case), both of which received advanced cardiac life support and a treatment regimen consisting of sodium bicarbonate, adrenaline and potassium. Both these patients survived beyond their initial rapid deterioration and cardiovascular collapse to be discharged from hospital without sequelae...
January 2009: Anaesthesia and Intensive Care
T J Olgers, J E Tulleken, W E Monteban-Kooistra, J J M Ligtenberg, J H Meertens, J G Zijlstra
A 37-year-old woman was admitted to the emergency room because of an autointoxication with hydroxychloroquine, leading to haemodynamic instability. Treatment consisted of the rapid administration of intravenous diazepam, after which the hypotension recovered rapidly even though no vasoactive medication was given. Treatment with diazepam has been advised in the Netherlands for many years in case of severe hydroxychloroquine intoxication, despite the fact that convincing evidence for its use is lacking. On the basis of the experience with the relevant cases, the administration of diazepam, 2 mg/kg initially followed by 2 mg/kg/24 hours as a continuous infusion, should certainly be considered for supportive treatment in the ICU in case of severe haemodynamic instability...
March 1, 2008: Nederlands Tijdschrift Voor Geneeskunde
Anna Ling Ngan Wong, Ian Tsz Fung Cheung, Colin A Graham
Hydroxychloroquine poisoning has rarely been reported in the literature, with only 18 cases being found on searching the literature. In this paper, we report a case that occurred in Hong Kong, and we make recommendations for emergency management of hydroxychloroquine overdose based on our and other's experience.
February 2008: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
F Mongenot, Y Tessier Gonthier, F Derderian, M Durand, D Blin
We report a case of massive overdose of hydroxychloroquine treated with circulatory assistance by peripheral extracorporeal circulation (ECC). We expose the case of a 39-year-old woman who ingested 12 g of hydroxychloroquine with bromazepam, paroxetine, and zolpidem, in a suicide attempt. Patient has developed central nervous system depression, hemodynamic failure, life-threatening ventricular arrhythmias, and serious hypokalemia. Initially the patient has received conventional treatment with gastric lavage and activated charcoal for gastrointestinal decontamination, blood volume expansion and vasopressive drugs, intubation and mechanical ventilation, high dose of diazepam, and potassium replacement...
February 2007: Annales Françaises D'anesthèsie et de Rèanimation
Bruno Mégarbane, Dabor Résière, Romain Sonneville, Gilles Guerrier, Nicolas Deye, Frédéric Baud
INTRODUCTION: Toxic effects of hydroxychloroquine, like chloroquine, include membrane stabilization and hypokalemia, which is correlated with the severity of the overdose. Correction of hypokalemia can expose patients to the risk of ventricular arrhythmia. CASE: A 19-year-old woman who had ingested 6 grams of hydroxychloroquine was admitted to intensive care with severe hypokalemia (1.5 mmol/L on admission). Thirty-six hours after correction of the hypokalemia, circulatory arrest followed ventricular fibrillation...
July 23, 2005: La Presse Médicale
E Reed Smith, Wendy Klein-Schwartz
Ingestion of 1-2 tablets of chloroquine or hydroxylchloroquine is thought to predispose children under 6 years of age to serious morbidity and mortality. The actual risk to the toddler and appropriate guidelines for care remain unclear at a time when both medications are therapeutically utilized as anti-inflammatory agents in addition to their main use as anti-parasitics. A review of the literature and data from the American Association of Poison Control Centers reveals instances where exposure to as little as 1-2 tablets of chloroquine resulted in serious consequences...
May 2005: Journal of Emergency Medicine
S Yanturali, E Aksay, O F Demir, R Atilla
We report a case presenting with massive overdose of hydroxychloroquine who survived without any sequelae. A 17-year-old girl presented to the Emergency Department 45 min after the ingestion of 22 g of hydroxychloroquine in a suicide attempt. We believe this is highest dose yet reported in the medical literature. The patient developed hypotension, life-threatening ventricular arrhythmias and mild hypokalemia. She was managed with saline infusion and dopamine for hypotension, gastric lavage and activated charcoal for decontamination, lidocain, magnesium sulfate and defibrillation for pulseless ventricular tachycardia...
March 2004: Acta Anaesthesiologica Scandinavica
K Marquardt, T E Albertson
Hydroxychloroquine overdoses are rarely reported with 7 previous cases found in the English medical literature. We report a case and review the literature. A 16-year-old girl ingested a handful of hydroxychloroquine 200mg, 30 minutes before presentation and presented with tachycardia (heart rate 110 beats/min), hypotension (systolic blood pressure 63 mm Hg), central nervous system depression, conduction defects (QRS = 0.14 msec), and hypokalemia (K = 2.1 meq/L). She was treated with fluid boluses and dopamine, oxygen, and potassium supplementation...
September 2001: American Journal of Emergency Medicine
P Jordan, J G Brookes, G Nikolic, D G Le Couteur
BACKGROUND: The management and toxicokinetics of hydroxychloroquine overdose are poorly described. CASE REPORT: We report a case of an 18-year-old girl who ingested 20 g of hydroxychloroquine. She developed marked hypokalemia, hypotension, and ventricular tachyarrhythmias but survived with treatment including intubation, adrenaline infusion, high-dose diazepam, and aggressive potassium replacement. Plasma hydroxychloroquine level was 29.40 mumol/L (9.87 mg/L) 2 hours after ingestion and the elimination half-life of hydroxychloroquine was 22 hours...
1999: Journal of Toxicology. Clinical Toxicology
M Mavrikakis, S Papazoglou, P P Sfikakis, G Vaiopoulos, K Rougas
OBJECTIVE: To report clinical experience from patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who were receiving recommended doses of hydroxychloroquine for more than six years, and were monitored for evidence of hydroxychloroquine related retinopathy every six months. METHODS: A prospective (and continuing) evaluation was made of the potential retinal toxicity of hydroxychloroquine in a cohort of 360 Greek patients followed for RA and SLE, 58 of whom have received long term treatment ( > six years)...
March 1996: Annals of the Rheumatic Diseases
M Nissilä, H Isomäki, K Kaarela, P Kiviniemi, J Martio, S Sarna
The prognosis 3 years after the onset of the disease was studied in 107 patients with definite rheumatoid arthritis, 161 with probable RA or non-specific arthritis, 84 with either ankylosing spondylitis, Reiter's disease or reactive arthritis, 14 with psoriatic arthritis and 10 with a systemic connective tissue disease. Prognosis was measured by clinical involvement of joints, radiological erosions in joints, deterioration in joint function, ESR, and working ability. A total of 44% of all patients were symptomless after 3 years...
1983: Scandinavian Journal of Rheumatology
S E Tett, D J Cutler, R O Day, K F Brown
1. Five healthy volunteers received, in a randomised crossover design study, a 155 mg oral tablet and an intravenous infusion of 155 mg racemic hydroxychloroquine (200 mg hydroxychloroquine sulphate) to assess the bioavailability of the commercially available tablet (Plaquenil, Winthrop Laboratories, Australia). 2. The terminal elimination half-life of hydroxychloroquine is more than 40 days, thus blood and urine samples were collected for 5 months following each dose to characterise adequately the terminal elimination phase and obtain accurate estimates of the areas under the concentration-time curves...
June 1989: British Journal of Clinical Pharmacology
A V Kemmenoe
A 2 1/2-year-old boy was hospitalized following ingestion of an estimated 60 tablets of 200-mg hydroxychloroquine. Upon death from cardiorespiratory arrest, analytes from the stomach, small intestine, liver, and plasma were examined using UV spectroscopy, thin-layer chromatography, and gas chromatography/mass spectrometry. Results indicate modest drug amounts in the stomach and small intestine, but much higher levels in the blood and liver extracts, suggesting that a considerable overdose was consumed.
May 1990: Journal of Analytical Toxicology
M Easterbrook
Ninety-five percent of patients on chloroquine demonstrate corneal deposition of the drug with the pupil dilated; less than 10% of patients on hydroxychloroquine show any corneal changes when so examined. I describe one patient on chloroquine and two on hydroxychloroquine who demonstrated large amounts of corneal antimalarial drug, leading to the early diagnosis of definite retinopathy. Examination of the cornea with the pupil dilated may reveal the presence of retinal toxicity in some patients.
August 1990: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
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