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Mini Episode: Managing Crashing Hydroxychloroquine/Chloroquine OD
Quick Review: Chloroquine and Hydroxychloroquine Toxicity
Toxic Dose
- Chloroquine: >5 g is associated with severe toxicity (though toxicity can occur at lower doses).
- Hydroxychloroquine (HCQ): Toxic dose is less well-defined.
Clinical Effects
- Seizures: Due to sodium channel blockade.
- Arrhythmias: Resulting from sodium channel blockade.
- Hypotension: Caused by alpha-adrenergic blockade.
- Hypokalemia: Often a notable feature.
Management
- Decontamination:
- Administer activated charcoal if the patient is awake, alert, and has no risk of emesis.
- Supportive Care:
- High-dose epinephrine:
- Recommended dose: 0.25 mcg/kg/min.
- Based on retrospective case-control series: https://www.nejm.org/doi/full/10.1056/NEJM198801073180101
- Diazepam:
- Administer 1–2 mg/kg over 30 minutes, followed by 1–2 mg/kg over 24 hours.
- Prevents seizures and may provide cardioprotective effects.
- Airway Management:
- Consider early intubation to secure the airway in deteriorating cases.
- Expert Consultation:
- Contact a poison center for guidance: 1-800-222-1222.
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