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Related Experiment Video

Updated: Nov 27, 2025

Optimized Griess Reaction for UV-Vis and Naked-eye Determination of Anti-malarial Primaquine

Optimized Griess Reaction for UV-Vis and Naked-eye Determination of Anti-malarial Primaquine

Published on: October 11, 2019

Primaquine overdose in a toddler.

Timothy Visclosky¹, William Schaeffer¹, Elaine Pomeranz²

¹Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America.

The American Journal of Emergency Medicine

|December 6, 2020

Summary

Accidental primaquine overdose in a child with undiagnosed glucose-6-phosphate dehydrogenase (G6PD) deficiency led to severe methemoglobinemia and hemolytic anemia. Treatment involved ascorbic acid and blood transfusion, highlighting the need for awareness in pediatric antimalarial toxicity.

Keywords:

Hemolytic Anemia Methemoglobinemia Overdose Pediatric Primaquine

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Area of Science:

Toxicology
Pediatrics
Pharmacology

Background:

Antimalarial drugs like primaquine can cause serious side effects, including methemoglobinemia and hemolytic anemia.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency amplifies these risks, potentially leading to life-threatening conditions.
Methylene blue, a common treatment for methemoglobinemia, can exacerbate hemolysis in G6PD-deficient individuals.

Observation:

A toddler with undiagnosed G6PD deficiency experienced an accidental primaquine overdose.
The patient developed severe methemoglobinemia and hemolytic anemia within two days.
Initial treatment with methylene blue preceded the diagnosis of G6PD deficiency.

Findings:

The patient received subsequent treatment with ascorbic acid and a blood transfusion.
Clinical condition improved gradually, leading to successful discharge.
This case highlights a rare instance of mixed methemoglobinemia and hemolytic toxicity in a pediatric patient due to primaquine overdose and G6PD deficiency.

Implications:

Pediatric patients constitute the majority of primaquine overdose cases.
Accurate diagnosis and prompt management of antimalarial toxicity in children with G6PD deficiency are critical.
Clinicians must maintain a high index of suspicion for G6PD deficiency in pediatric patients presenting with symptoms of antimalarial toxicity.