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Quinine Poisoning

Quinine Toxicity


Presentation

  • Abstract Two cases of acute blindness due to quinine poisoning are presented. In both cases, the diagnosis was initially unsuspected.[ncbi.nlm.nih.gov]
  • We have reviewed quinine poisoning as presented in the medical literature and our experience of paediatric quinine poisoning during the period from January 1975 to September 1986.[ncbi.nlm.nih.gov]
  • Quinidine-like cardiotoxic effects may or may not be present. Specific levels. Serum quinine levels can be measured by the same assay as for quinidine, as long as quinidine is not present.[mhmedical.com]
  • We report the case of a 57-year-old man who presented with acute confusion and bilateral blindness after consuming approximately 7.2 g quinine sulphate along with an unknown quantity of alcohol.[journals.lww.com]
  • Two styles of presentation have been adopted. Certain topics are discussed in depth either because of their clinical importance or because recent data have become available concerning pathophysiology or treatment.[books.google.com]
Asymptomatic
  • Ten children either remained asymptomatic or made a complete recovery. Two children had a persisting major deficit and one died.[ncbi.nlm.nih.gov]
  • If asymptomatic with a normal ECG they are medically cleared. All patients with a deliberate overdose require 6 hours observation and cardiac monitoring. If asymptomatic with a normal ECG they are medically cleared.[lifeinthefastlane.com]
  • Asymptomatic patients with retinal crystals may be monitored. Most patients may be continued on the medication, as it is truly needed in the treatment of their underlying disease process.[retinalphysician.com]
Gastric Lavage
  • Once ingestion of quinine has occurred, absorption should be prevented by the emptying of the stomach with ipecacuanha or gastric lavage promptly and then by the administration of activated charcoal.[ncbi.nlm.nih.gov]
  • The benefit of gastric lavage is doubtful but the use of activated charcoal should be considered.[southsudanmedicaljournal.com]
  • Gastric lavage is used in cases where medications have been ingested that activated charcoal would absorb poorly (eg, iron, lithium) and for sustained-release formulations or enteric-coated tablets.[patient.info]
Rigor
  • Rigor mortis sets in exceedingly early, and, on opening the thorax immediately after death, the heart is found contracted, rigid, motionless, and totally empty.[books.google.com]
Gangrene
  • . — Putrid gangrenous ulcers on the lower extremities ; great sensitiveness to dampness ; pulse weak and slow ; chilliness and shuddering ; oedema of the part. ‏[books.google.com]
Pallor
  • Funduscopy may reveal retinal artery spasm, disc pallor, and macular edema. Although gradual recovery occurs, many patients are left with permanent visual impairment.[mhmedical.com]
Sore Throat
  • الصفحة 137 - Sore throat ; fauces and pharynx deep red, soft palate and tonsils swollen ; swallowing painful, particularly fluids ; speech thick, feels like a lump in the throat which induces hawking; throat swollen outside and sensitive to the touch.[books.google.com]
  • throat fast or irregular heartbeat chest pain weakness sweating dizziness Quinine may cause other side effects.[medlineplus.gov]
Ulcer
  • . — Putrid gangrenous ulcers on the lower extremities ; great sensitiveness to dampness ; pulse weak and slow ; chilliness and shuddering ; oedema of the part. ‏[books.google.com]
  • (Tikosyn), flecainide (Tambocor), procainamide (Procanbid, Pronestyl), quinidine, and sotalol (Betapace); certain medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin); medications for ulcers[medlineplus.gov]
  • Ulcer-healing drugs: Cimetidine inhibits quinine metabolism leading to increased plasma-quinine concentrations. Pregnancy Large doses of quinine can induce abortion. Quinine may cause congenital abnormalities of the CNS and extremities.[medicines.org.uk]
Photophobia
  • Blurred vision, diplopia, reduced visual fields, disturbed color perception, photophobia, scotomata and blindness are all potential ocular side effects, whereas cardiac dysrhythmia is a side effect of this medicine on the cardiovascular system.[ic.steadyhealth.com]
  • Visual disturbances consist of blurred vision, disturbed colour perception, photophobia, diplopia, night blindness, constricted visual fields, scotoma, mydriasis, and, very rarely, even blindness.[home.intekom.com]
Visual Field Constriction
  • Eye disorders Blurred vision, defective colour perception, visual field constriction. Ear and labyrinth disorders Tinnitus, impaired hearing.[medicines.org.uk]
Suggestibility
  • We suggest that in cases of quinine poisoning, charcoal haemoperfusion may be a safe and effective method of drug removal, to be used with stellate ganglion block.[ncbi.nlm.nih.gov]
  • We suggest that restricted prescribing for leg cramps, better patient education about the toxic nature of the drug, and clear labelling of this hazard on the dispensing bottles might lead to a reduction in the cases of quinine poisoning.[journals.lww.com]
  • But, no evidence suggests that quinine is effective for RLS. Other cramping conditions. Some evidence suggests that quinine can reduce the severity and occurrence of leg cramps in people on dialysis for kidney disease.[consumerreports.org]
  • “This new work with malaria patients shows that our earlier suggestions are largely borne out in the clinic.[futurity.org]
  • Have a suggestion, idea, or comment? Send us your feedback. Boost your vocabulary! Get the SpanishDict Word of the Day in your inbox A new word each day Native speaker examples Quick vocabulary challenges[spanishdict.com]
Ataxia
  • Quinine is known to cause deterioration in patients with myasthenia gravis and erythema multiforme, to stimulate insulin release in patients receiving treatment for falicparum malaria, and to be responsible at times for ataxia following moderate overdosage[ncbi.nlm.nih.gov]
  • Severe intoxication may cause ataxia, confusion, obtundation, convulsions, coma, and respiratory arrest.[mhmedical.com]
Stupor
  • Treat coma (See Coma and stupor ), seizures (See Seizures ), hypotension (See Hypotension ), and arrhythmias (See QRS interval prolongation, Tachycardia, and Ventricular dysrhythmias ) if they ...[mhmedical.com]

Workup

First-Degree Atrioventricular Block
  • In addition, tinnitus, decreased hearing, vomiting, abdominal pain, and confusion were noted in one patient, and the other experienced decreased hearing, headache, confusion, tachycardia, later bradycardia, and first-degree atrioventricular block.[ncbi.nlm.nih.gov]

Treatment

  • Attempts at treatment by active removal have proved unsuccessful because of its high degree of protein binding. We describe two cases of non-accidental overdose of quinine (19.5 g and 15 g) with potentially fatal serum quinine levels.[ncbi.nlm.nih.gov]
  • Treatment with a forced acid diuresis and bilateral stellate ganglion blocks is described.[ncbi.nlm.nih.gov]
  • The purpose of this book is to provide an up-to-date account of the diag nosis and treatment of all the clinically important poisons.[books.google.com]
  • Quinine was once widely used for treatment of malaria and is still occasionally used for chloroquine-resistant cases.[mhmedical.com]
  • Treatment courses are reviewed.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis The younger the person, the better the chance for improvement with occlusion and vision therapy. However, treatment may be successful in older children—even adults.[medical-dictionary.thefreedictionary.com]

Etiology

  • In patients with reduced glomerular filtration rate, unmetabolized quinine is reabsorbed in the distal renal tubule by passive back diffusion, potentially resulting in a dangerously high tissue and serum level of quinine. 6 The etiology of hypoglycemia[healio.com]

Epidemiology

  • Epidemiology In 2012, 110,960 self-harm cases were admitted to NHS hospitals in Englnd in the 12 months to August 2012 - a 0.4 per cent increase on the previous 12-month period (110,490). [ 1 ] In England and Wales, between 2013 and 2014, accidental poisonings[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Certain topics are discussed in depth either because of their clinical importance or because recent data have become available concerning pathophysiology or treatment.[books.google.com]
  • Because of the pathophysiology of the diseased kidney, patients with renal impairment are at particular risk of toxicity, particularly severe life-threatening hypoglycemia.[healio.com]

Prevention

  • Once ingestion of quinine has occurred, absorption should be prevented by the emptying of the stomach with ipecacuanha or gastric lavage promptly and then by the administration of activated charcoal.[ncbi.nlm.nih.gov]
  • They seem to prefer delivering over all mankind to the gravedigger, to listening to the good counsel of the new purified healing art But who can prevent them acting so, as they alone possess the power in the state to suppress what is good... ‏[books.google.com]
  • It should not be taken to prevent malaria. Other antimalarials should be used to prevent malaria.[netdoctor.co.uk]
  • Switzerland: Springer International Publishing. 2015 Abstract Chloroquine is used to prevent and treat malaria in limited geographical areas (e.g., Central America and the Far East) and to manage immunological disorders such as systemic lupus erythematosus[ro.uow.edu.au]
  • Drug products for the treatment and/or prevention of nocturnal leg muscle cramps for over-the-counter human use. Federal Register. Aug 22, 1994;59(161):43234-52. Jaeger A, Sauder P, Kopferschmitt J, et al.[healio.com]

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