Are 1-2 dangerous? Chloroquine and hydroxychloroquine exposure in toddlers

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. Based on these findings, ingestions of greater than 10 mg/kg of chloroquine base or unknown amounts require triage to the nearest health care facility for 4-6 h of observation. There is very limited data on pediatric hydroxychloroquine overdoses and no reports of toxicity from 1-2 pills, but given its similarity to chloroquine, it also should be considered potentially toxic at small doses. Thus, similar recommendations should be followed for triage after accidental hydroxychloroquine overdose.