Hydroxychloroquine overdose: case report and recommendations for management

@article{LingNganWong2008HydroxychloroquineOC,
  title={Hydroxychloroquine overdose: case report and recommendations for management},
  author={Anna Ling Ngan Wong and Ian Tsz Fung Cheung and Colin Alexander Graham},
  journal={European Journal of Emergency Medicine},
  year={2008},
  volume={15},
  pages={16-18}
}
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. 

Survival after Massive Hydroxychloroquine Overdose

TLDR
Both patients survived beyond their initial rapid deterioration and cardiovascular collapse to be discharged from hospital without sequelae and demonstrated rapid recovery from a pre-arrest condition, following aggressive correction of electrolyte and pH disturbance and rapid distribution of the drug to peripheral tissues.

Hydroxychloroquine Toxicity Management: A Literature Review in COVID-19 Era

TLDR
The acute HCQ toxicity may result during the treatment period of COVID-19 and the most common options can use in this situation include included gastric lavage and decontamination, IV fluid resuscitation, potassium replacement, sodium bicarbonate, intravenous lipid emulsion and extracorporeal circulation membrane oxygenation.

Cardiac Complications Attributed to Hydroxychloroquine: A Systematic Review of the Literature Pre-COVID-19

TLDR
Evaluating the incidence of cardiotoxicity associated with hydroxychloroquine prior to the onset of COVID-19 found the majority of patients improved with the withdrawal of hydroxy chloroquine and standard therapy, and further studies are needed to understand the impact of CO VID-19 on the cardiovascular system.

Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

TLDR
Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication, and sodium bicarbonate appears to be useful and safe in case of QRS widening.

Intravenous Lipid Emulsion Use for Severe Hydroxychloroquine Toxicity.

TLDR
Criteria for severe poisoning are hypotension, prolonged QRS, ventricular dysrhythmias, and severe hypokalemia, and greater than 4 g has been proposed as a criterion for severe HCQ overdose.

Accidental hydroxychloroquine overdose resulting in neurotoxic vestibulopathy

TLDR
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 is presented, resulting in permanent neurotoxic vestibulopathy.

Extracorporeal Treatment for Chloroquine, Hydroxychloroquine, and Quinine Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup.

TLDR
Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug, and the EXTRIP workgroup recommends against using extacorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.

Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose

TLDR
Evidence from COVID-19 treatment suggests QT/QTc prolongation is of concern, particularly when used in combination with azithromycin, although disagreement exists across studies.

Hydroxychloroquine in COVID-19: therapeutic promises, current status, and environmental implications

TLDR
The therapeutic potential of HCQ in the treatment of CO VID-19 is reviewed based on the available in vitro and clinical evidence, current status of registered HCQ-based clinical trials investigating therapeutic options for COVID-19, and environmental implications ofHCQ.

References

SHOWING 1-10 OF 19 REFERENCES

Hydroxychloroquine overdose: toxicokinetics and management.

TLDR
The clinical manifestations of the 18-year-old girl who ingested 20 g of hydroxychloroquine developed marked hypokalemia, hypotension, and ventricular tachyarrhythmias but survived with treatment including intubation, adrenaline infusion, high-dose diazepam, and aggressive potassium replacement.

Massive hydroxychloroquine overdose

TLDR
A 17‐year‐old girl presenting with massive overdose of hydroxychloroquine who survived without any sequelae in a suicide attempt is reported, believed to be the highest dose yet reported in the medical literature.

The use of diazepam in chloroquine poisoning

  • A. Rajah
  • Medicine, Psychology
    Anaesthesia
  • 1990
TLDR
Experimental and clinical evidence is presented to show that diazepam in varying doses significantly decreases the mortality rate.

Treatment of hydroxychloroquine overdose.

TLDR
A 16-year-old girl ingested a handful of hydroxychloroquine 200mg, 30 minutes before presentation and presented with tachycardia, hypotension, central nervous system depression, conduction defects, and hypokalemia, which gradually decreased over 3 days.

[A patient with acute hydroxychloroquine poisoning; recommendation for treatment].

TLDR
A 30-year-old man for whom Plaquenil had been prescribed for rheumatoid arthritis, and who had taken 4 g orally to end his life, survived the intoxication and is now under psychiatric treatment.

Treatment of severe chloroquine poisoning.

TLDR
Preliminary data suggest that combining early mechanical ventilation with the administration of diazepam and epinephrine may be effective in the treatment of severe chloroquine poisoning.

Amrinone for refractory cardiogenic shock following chloroquine poisoning

TLDR
Arinone, a bipyridine analog, was successfully used to improve haemodynamic conditions in a 17-year-old man who ingested an 8 g chloroquine overdose and cardiogenic shock was refractory to epinephrine, dopamine and molar sodium lactate.

Population Pharmacokinetics of Hydroxychloroquine in Patients With Rheumatoid Arthritis

TLDR
A population PK model was successfully developed for HCQ, and steady-state drug concentrations and maintenance dosage requirements were similar, and the population estimate of bioavailability of 0.75 was consistent with literature values.

Clinical Features and Management of Poisoning due to Antimalarial Drugs

TLDR
The general management of antimalarial overdose include gastric lavage and symptomatic treatment, and experimental and clinical data have shown that diazepam may reverse chloroquine cardiotoxicity.