Abstract
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. Additional treatments included intravenous diazepam, epinephrine, norepinephrine, sodium bicarbonate, and magnesium sulfate. Despite the ongoing hemodynamic instability, the patient was also treated with Intralipid (ILE) and received hemodialysis. Improvements in her hemodynamics were observed after 18 hours. She survived her massive overdose of HCQ. Conclusion. HCQ poisoning is rare but serious because of its rapid progression to life-threatening symptoms. Hemodynamic support, gastric decontamination, electrolyte monitoring and replacement, and management of arrhythmias are the mainstays of treat...Continue Reading
References
Jan 1, 1992·Annales Françaises D'anesthèsie Et De Rèanimation·J DemaziereL Marcoux
Jan 1, 1989·British Journal of Clinical Pharmacology·D Lockey, D N Bateman
Jan 1, 1989·British Journal of Clinical Pharmacology·L F PrescottR Heyworth
Jul 1, 1987·Medical Toxicology and Adverse Drug Experience·A JaegerF Flesch
May 1, 1983·Journal of Toxicology. Clinical Toxicology·J CrouzetteP E Fournier
Sep 30, 1995·Lancet·J L ClemessyF J Baud
Feb 10, 1996·Lancet·P J Cooper
Jul 1, 1996·Critical Care Medicine·J L ClemessyF J Baud
Oct 23, 1997·Critical Care Clinics·P F Kolecki, S C Curry
May 14, 1998·Anesthesiology·G L WeinbergM J Cwik
Sep 14, 2001·The American Journal of Emergency Medicine·K Marquardt, T E Albertson
Jul 5, 2002·The American Journal of Emergency Medicine·Geoffrey K IsbisterIan M Whyte
May 29, 2003·Regional Anesthesia and Pain Medicine·Guy WeinbergWilliam Hoffman
Apr 18, 2006·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Chun-Yu ChenChih-Chuan Lin
Jul 1, 2006·Anesthesiology·Meg A RosenblattJames B Eisenkraft
Jul 27, 2006·Anaesthesia·R J LitzT Koch
Nov 10, 2006·Annales Françaises D'anesthèsie Et De Rèanimation·F MongenotD Blin
Sep 4, 2007·Annals of Emergency Medicine·Archie J SirianniFred M Henretig
Feb 4, 2009·Antimicrobial Agents and Chemotherapy·Hyeong-Seok LimJae-Won Park
Oct 7, 2010·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Leelach RothschildGuy Weinberg
Citations
Aug 3, 2016·Medicina intensiva·C Merino ArgumánezJ A Sanchez Izquierdo
Apr 14, 2017·BMJ Case Reports·Peter B Chansky, Victoria P Werth
Aug 21, 2020·Modern Rheumatology·Kanako NodaHajime Hosoi
Jun 10, 2020·Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology·Peter R ChaiT B Erickson
Sep 24, 2020·Journal of the American Society of Nephrology : JASN·Ingrid BerlingUNKNOWN EXTRIP workgroup
May 11, 2021·Case Reports in Emergency Medicine·Goswin Onsia, Sarah Bots