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Published on: June 20, 2020
Prolongation of QT interval due to hydroxychloroquine overdose used in COVID-19 treatment
Gökhan Aksel1, Mehmet Muzaffer Islam1, Tuncay Aslan1
1Department of Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.
Insights
A young patient experienced QT interval prolongation and bradycardia after accidentally taking 1,600 mg of hydroxychloroquine for COVID-19 treatment. This case highlights the cardiac risks associated with hydroxychloroquine, even at lower doses.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Hydroxychloroquine was widely used for COVID-19 treatment.
- Cardiac side effects, including QT interval prolongation, are known risks.
- Patient education and monitoring are crucial for medications with potential cardiac effects.
Observation:
- A 28-year-old male presented with nausea, diarrhea, and weakness after a hydroxychloroquine overdose (1,600 mg).
- Electrocardiography revealed sinus bradycardia and a prolonged corrected QT interval (510 ms).
- The patient was hospitalized and discharged after his QT interval normalized (420 ms) and bradycardia resolved.
Findings:
- This is the first reported case of QT interval prolongation at a relatively low hydroxychloroquine dose of 1,600 mg.
- Accidental overdose of hydroxychloroquine can lead to significant cardiac adverse events.
- Early detection and management of cardiac side effects are essential.
Implications:
- Healthcare providers must educate patients on hydroxychloroquine dosage and potential side effects.
- Serial ECG monitoring is recommended for hospitalized patients on hydroxychloroquine.
- Further research into the cardiac safety profile of hydroxychloroquine at various doses is warranted.
Abstract:
Hydroxychloroquine is one of the most commonly used drugs in COVID-19 treatment. In this case report, we aimed to present a young patient whose QT interval was prolonged due to hydroxychloroquine overdose which was given for COVID-19 treatment. This is the first reported case of QT interval prolongation at a low dose of 1.600 mg in the literature. A 28-year-old male patient was admitted to the emergency department with the complaints of nausea, diarrhea, and weakness. The patient was diagnosed with COVID-19 a day prior and home isolation was recommended with hydroxychloroquine and oseltamivir P. O. treatment. His complaints started 6 h after accidentally taking 1.600 mg of hydroxychloroquine P. O. at the same time. On physical examination, the Glasgow Coma Scale was 15, and neurological, respiratory, and abdominal examinations were normal. His pulse was 54 beats/min, oxygen saturation was 99%, arterial blood pressure was 122/82 mmHg, and fever was 36.5°C. Electrocardiography (ECG) showed sinus bradycardia and corrected QT interval was calculated as 510 ms. The QT interval prolongation and bradycardia persisted, and the patient was hospitalized for follow-up and treatment. He was discharged on the 3rd day of his hospitalization after the corrected QT interval was detected to be 420 ms and his bradycardia improved. Due to the potential cardiac side effects, patients who are sent to home isolation with treatment should be educated about the use, dosage, and possible side effects of this medicine, and serial ECG monitoring should be provided to patients who are hospitalized.
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