Early treatment with intravenous lipid emulsion in a potentially lethal hydroxychloroquine intoxication

R Ten Broeke, E Mestrom, L Woo, H Kreeftenberg

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)

Abstract

This case report describes the possible benefit of intravenous lipid emulsion in two patients surviving a severe intoxication with hydroxychloroquine in a dose that was previously considered to be lethal. The first case involves a 25-year-old female who ingested 17.5 grams of hydroxychloroquine, approximately one hour before presentation. An ECG showed QRS widening and the lab results showed hypokalaemia. She became unconscious, and developed hypotension and eventually apnoea. After intubation, supportive care consisted of norepinephrine and supplementation of potassium. Moreover, sodium bicarbonate and intravenous lipid emulsion were started to prevent cardiac toxicity. After these interventions, haemodynamic stability was established within a few hours. Although cardiomyopathy was confirmed, the patient recovered after two weeks. The second case concerns a 25-year-old male who took 5 grams of hydroxychloroquine. At presentation, two hours after intake, he showed QTc prolongation and hypokalaemia. The patient was treated with the usual supportive care and, although presentation to hospital was later, with intravenous lipid emulsion. Also this patient recovered. In conclusion, these cases show the benefit of supplemental intravenous lipid emulsion to prevent cardiac toxicity after a severe intoxication with hydroxychloroquine.

Original languageEnglish
Pages (from-to)210-4
Number of pages5
JournalThe Netherlands Journal of Medicine
Volume74
Issue number5
Publication statusPublished - Jun 2016

Keywords

  • Adult
  • Arrhythmias, Cardiac/drug therapy
  • Chromatography, Liquid
  • Drug Overdose/complications
  • Electrocardiography
  • Fat Emulsions, Intravenous/therapeutic use
  • Female
  • Humans
  • Hydroxychloroquine/metabolism
  • Hypokalemia/drug therapy
  • Hypotension/drug therapy
  • Male
  • Norepinephrine/therapeutic use
  • Potassium Chloride/therapeutic use
  • Sodium Bicarbonate/therapeutic use
  • Suicide, Attempted
  • Tandem Mass Spectrometry
  • Vasoconstrictor Agents/therapeutic use

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