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Quinine Toxicity

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Quinine Toxicity, Quinine Poisoning, Quinine Overdose, Quinine Intoxication, Cinchonism

  • See Also
  1. Quinine
  • Mechanism
  1. Quinine is a Class Ia Antiarrhythmic Drug
  2. Quinine in Overdose blocks cardiac Sodium channels
    1. Decreased cardiac inotropy
    2. Decreased cardiac conduction velocity
  3. Quinine in Overdose blocks cardiac Potassium channels
    1. Repolarization is prolonged
  4. Other Quinine effects in Overdose
    1. Anticholinergic Toxicity
    2. Increased Insulin release
    3. Ototoxicity
    4. Ophthalmic toxicity
    5. Vasodilation
  • Pharmacokinetics
  1. See Quinine
  2. Severe toxicity is associated with ingestions >1.5 to 8 grams
  • Adverse Effects
  • Toxicity
  1. Cinchonism (reversible Quinine Toxicity)
    1. Vasodilation
    2. Gastrointestinal symptoms
      1. Nausea or Vomiting
      2. Diarrhea
    3. Neurologic
      1. Tinnitus
      2. Dizziness
      3. Headache
  2. Severe Quinine Toxicity
    1. Cardiac
      1. Dysrhythmias
      2. EKG Abnormalities (e.g. Prolonged QTc, QRS Complex or PR Segment)
      3. Hypotension
    2. Miscellaneous
      1. Retinal ischemia (Retinal edema, Decreased Visual Acuity)
      2. Hypokalemia
      3. Hypoglycemia
  • Labs
  1. See Unknown Ingestion
  • Management
  1. Multidose Activated CharcoalDecontamination
    1. Start Activated Charcoal 1 g/kg
    2. Continue with 0.5 g/kg every 6 hours for 24 hours
  2. Hypoglycemia
    1. See Hypoglycemia Management
    2. Intravenous Dextrose
    3. Consider Octreotide 50 mcg SQ every 6 hours
  3. Wide QRS (>100 ms) with Hypotension
    1. Sodium Bicarbonate boluses until QRS narrows, hemodynamic stability
    2. Concurrently manage Hypokalemia (worsens with Sodium Bicarbonate)
  4. Prolonged QTc with Torsades de Pointes
    1. See Torsades de Pointes
    2. ABC Management
    3. Defibrillation, overdrive pacing
    4. Magnesium Sulfate IV
  5. Disposition
    1. Admit symptomatic patients
    2. May discharge asymptomatic patients after 6-12 hours
  • Resources
  1. Quinine Toxicity (Life in the Fast Lane)
    1. https://litfl.com/quinine-toxicity/
  • References
  1. Carroll and Yakey (2024) Crit Dec Emerg Med 38(12): 32
  2. Langford (2003) Br J Clin Pharmacol 56(5):576-8 +PMID: 14651733 [PubMed]