Hydroxychloroquine from Safety to Death: Case Series

Abdelkader, Salma; Mahmoud, Alaa Essam; Wahdan, Maha Magdy; El Morsy, Sarah

doi:10.21608/zjfm.2023.223504.1156

Hydroxychloroquine from Safety to Death: Case Series

Document Type : Original Article

Authors

¹ lecturerForensic medicine and clinical toxicology,faculty of medicine, ainshams unuiversity

² lecturer inForensic medicine and clinical toxicology department, faculty of medicine, ainshams university

³ Lecturer in Community Medicine, Environmental, and Occupational Medicine Department - Faculty of Medicine Ain Shams University, Cairo, Egypt.

⁴ Lecturer in Forensic medicine and clinical toxicology department, faculty of medicine, ainshams university

10.21608/zjfm.2023.223504.1156

Abstract

Introduction: Hydroxychloroquine (HCQ) has been used to treat many autoimmune diseases. Early in the era of the COVID-19 pandemic, HCQ was an essential arm in its management. Later, updated evidence had recommendations against its use in cases of COVID-19; however, its abundance in homes raised the risk of its misuse. Aim: This study aimed to describe patients with acute hydroxychloroquine toxicity who presented to the Poison Control Centre Ain Shams at University Hospitals (PCC-ASUH) including the management and the outcomes. Method: Medical records of patients with acute HCQ toxicity presented to PCC-ASUH from the beginning of December 2020 to the end of December 2021 were reviewed. Patients’ demographics, clinical parameters, laboratory investigations, electrocardiography (ECG) findings, treatment were presented and interpreted. Results: Eleven patients of acute HCQ poisoning during the study duration; ten survived, and one died. The most common presenting symptoms were vomiting and hypotension. The ECG abnormalities observed in two patients were wide QRS complexes and prolonged QT intervals. Patients were treated symptomatically. Hypotension was initially treated by intravenous (IV) fluids. Vasopressors were used in three patients. Conclusion: Although the incidence of acute HCQ toxicity is low, it can be fatal. The treatment is based mainly on early IV fluid resuscitation. The vasopressors were added to patients after the failure of fluid therapy. Patients required meticulous ECG and serum electrolytes monitoring, particularly serum Potassium (K) levels. Recommendations: The study recommended the early use of epinephrine as a vasopressor after the failure of IV fluid therapy to correct the hypotension in HCQ-poisoned patients. Intravenous diazepam should be considered with endotracheal intubation (ETT) and mechanical ventilation (MV) in the treatment.

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