Acute Hydroxychloroquine Overdose With Severe and Prolonged Cardiotoxicity

We present a case of an overdose of hydroxychloroquine with severe toxicity and describe the hospital management of the patient. The management of large ingestions can provide significant challenges for the emergency medicine physician, as these patients can present in extremis. A 49-year-old woman presented to the emergency department (ED) two hours following a reported ingestion of 24 grams of hydroxychloroquine in a suicide attempt. The patient developed hypotension, ventricular arrhythmias including torsades de pointes, and profound hypokalemia. She was managed with intravenous fluid resuscitation, mechanical ventilation, vasopressors, electrolyte replacement, high-dose intravenous diazepam, sodium bicarbonate, and lidocaine infusions. The patient was ultimately able to be discharged home neurologically intact. Reported hydroxychloroquine overdoses are relatively infrequent. Understanding the toxicity and management of hydroxychloroquine overdoses is particularly important now, as the prescription rate of hydroxychloroquine increased during the COVID-19 pandemic and has remained high despite the failure of studies to demonstrate a reduction in morbidity and mortality when used for the treatment of COVID-19.