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Chloroquine poisoning: ventricular fibrillation following 'trivial' overdose in a child
G G Collee1, G S Samra, G C Hanson
1Intensive Care Unit, Whipp's Cross Hospital, Leytonstone, London, UK.
Insights
A young boy survived chloroquine overdose after developing ventricular fibrillation. Early resuscitation and intensive monitoring are crucial for managing severe chloroquine poisoning, even at lower plasma concentrations.
Area of Science:
- Toxicology
- Cardiology
- Emergency Medicine
Background:
- Chloroquine is an antimalarial drug with known cardiac toxicity.
- Overdose can lead to severe cardiovascular complications, including fatal arrhythmias.
- Pediatric chloroquine poisoning cases are less common but require careful management.
Observation:
- A 13-year-old boy ingested approximately 750 mg of chloroquine base.
- He developed ventricular fibrillation shortly after gastric lavage.
- His plasma chloroquine concentration was 4.2 mumol/l, lower than typically associated with fatal outcomes in adults.
Findings:
- Prompt resuscitation from ventricular fibrillation was successful.
- The case highlights that significant cardiac events can occur at lower chloroquine plasma concentrations than previously reported for adults.
- The clinical and electrocardiographic effects of chloroquine poisoning were reviewed, along with management strategies.
Implications:
- Intensive care unit (ICU) admission with 24-hour electrocardiographic (ECG) monitoring and pulse oximetry is recommended for all patients with ECG changes after chloroquine overdose.
- Early recognition and management of cardiac arrhythmias are vital in chloroquine poisoning.
- This case underscores the potential for severe toxicity even with seemingly moderate ingestions.
Abstract:
A 13-year-old boy was admitted to hospital 45 min after the ingestion of approximately 750 mg of chloroquine base. A few minutes after gastric lavage with warm water he developed ventricular fibrillation from which he was promptly resuscitated. The plasma concentration of chloroquine was 4.2 mumol/l; significantly lower than the concentrations previously associated with a fatal outcome in adults. The clinical and electrocardiographic effects of chloroquine poisoning are discussed, and the literature reviewed regarding the role of specific management with diazepam and adrenaline infusions. A period of twenty four hours electrocardiographic (ECG) monitoring and pulse oximetry in an intensive care unit is advocated for all patient with ECG changes following chloroquine overdose.