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Acute Hydroxychloroquine Overdose With Severe and Prolonged Cardiotoxicity
William Richardson1,2, Dan Fisher3, Stanley Hassinger1
1Emergency Medicine, Prisma Health Midlands, Columbia, USA.
Cureus
|July 23, 2025
Summary
A hydroxychloroquine overdose case highlights severe toxicity, including hypotension and arrhythmias. Prompt emergency management with fluids, ventilation, and specific antidotes led to a full recovery.
Area of Science:
- Toxicology
- Emergency Medicine
- Pharmacology
Background:
- Hydroxychloroquine prescriptions remain high post-COVID-19, despite unproven efficacy.
- Overdoses of hydroxychloroquine present significant emergency management challenges.
Observation:
- A 49-year-old woman ingested 24 grams of hydroxychloroquine, leading to hypotension, ventricular arrhythmias (torsades de pointes), and hypokalemia.
- The patient presented to the emergency department in extremis.
Findings:
- Management involved fluid resuscitation, mechanical ventilation, vasopressors, electrolyte replacement, and infusions of diazepam, sodium bicarbonate, and lidocaine.
- The patient was successfully treated and discharged neurologically intact.
Implications:
- This case underscores the critical need for understanding and managing severe hydroxychloroquine toxicity.
- Effective emergency protocols are vital for patients with large ingestions of this medication.
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