Clinical Experience in the Use of Intravenous Lipid Emulsion in Hydroychloroquine and Chloroquine Overdose with Refractory Shock

Wong, OF; Chan, YC; Lam, SK; Fung, HT; Ho, Jky

doi:10.1177/102490791101800410

Cited by 13 publications

(7 citation statements)

References 19 publications

(21 reference statements)

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“…Lipid emulsion therapy did not lead to return of spontaneous circulation when given during cardiac arrest for either a hydroxychloroquine ingestion or a combined ingestion of hydroxychloroquine and chloroquine [40]. Two case reports suggest that lipid emulsion can reverse hypotension averting cardiac arrest [41,42].…”

Section: Treatment Of Chloroquine and Hydroxychloroquine Toxicitymentioning

confidence: 99%

COVID-19: Therapeutics and Their Toxicities

et al. 2020

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SARS-CoV-2 is a novel coronavirus that emerged in 2019 and is causing the COVID-19 pandemic. There is no current standard of care. Clinicians need to be mindful of the toxicity of a wide variety of possibly unfamiliar substances being tested or repurposed to treat COVID-19. The United States Food and Drug Administration (FDA) has provided emergency authorization for the use of chloroquine and hydroxychloroquine. These two medications may precipitate ventricular dysrhythmias, necessitating cardiac and electrolyte monitoring, and in severe cases, treatment with epinephrine and high-doses of diazepam. Recombinant protein therapeutics may cause serum sickness or immune complex deposition. Nucleic acid vaccines may introduce mutations into the human genome. ACE inhibitors and ibuprofen have been suggested to exacerbate the pathogenesis of COVID-19. Here, we review the use, mechanism of action, and toxicity of proposed COVID-19 therapeutics.

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Section: Treatment Of Chloroquine and Hydroxychloroquine Toxicitymentioning

confidence: 99%

COVID-19: Therapeutics and Their Toxicities

et al. 2020

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“…However, a definitive proof of a beneficial effect of ILE is lacking, as only two case reports mention the successful use of ILE without dialysis [28,29]. Another report describes two fatal cases of hydroxychloroquine poisoning in which the use of ILE was not successful [32]. One report of chloroquine poisoning mentions the administration of ILE after a long (prehospital) reanimation, after which there was return of spontaneous circulation [33].…”

Section: Discussionmentioning

confidence: 99%

Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

Onsia

Bots

2021

Case Reports in Emergency Medicine

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Background. In the context of the current COVID-19 pandemic, there has been renewed interest in the drug hydroxychloroquine. However, clinicians should be aware of the dangers of hydroxychloroquine intoxication, an insufficiently studied condition. Case Report. We present a case of autointoxication with 20 g hydroxychloroquine in a 35-year-old woman. Cardiac monitoring showed ventricular arrhythmias for which high-dose midazolam and propofol were initiated, resulting in a brief normalization of the cardiac rhythm. Because of the reoccurrence of these arrhythmias, intravenous lipid emulsion was administered with fast cardiac stabilization. Treatment with continuous norepinephrine, potassium chloride/phosphate, and sodium bicarbonate was initiated. On day 6, she was extubated and after 11 days, she was discharged from the hospital without complications. Conclusion. Since high-quality scientific evidence is lacking, treatment options are based on experience in chloroquine toxicity. Activated charcoal is advised if the patient presents early. Sedation with diazepam, early ventilation, and continuous epinephrine infusion are considered effective in treating severe intoxication. Caution is advised when substituting potassium. Despite the lack of formal evidence, sodium bicarbonate appears to be useful and safe in case of QRS widening. Intravenous lipid emulsion, with or without hemodialysis, remains controversial but appears to be safe. As a last resort, extracorporeal life support might be considered in case of persisting hemodynamic instability.

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“…Intravenous lipid emulsion use was reported in 2 pediatric cases included in this review, which both subsequently survived 18,21 . In adults, there are reported cases in which patients with acute hydroxychloroquine overdose died despite ILE use, which could be related to their late arrival to the emergency department (around 2.5 and 3 hours after ingestion) 52 . According to American College of Medical Toxicology, ILE is viewed as a reasonable consideration for therapy in circumstances where there is serious hemodynamic, or other, instability from a xenobiotic with a high degree of lipid solubility 58 .…”

Section: Discussionmentioning

confidence: 99%

Acute Hydroxychloroquine Overdose

Pejčić¹

2021

Pediatr Emer Care

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Objectives: This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management.Methods: Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made.Results: Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy-sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died.Conclusions: Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.

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Clinical Experience in the Use of Intravenous Lipid Emulsion in Hydroychloroquine and Chloroquine Overdose with Refractory Shock

Cited by 13 publications

References 19 publications

COVID-19: Therapeutics and Their Toxicities

COVID-19: Therapeutics and Their Toxicities

Nearly Fatal Hydroxychloroquine Overdose Successfully Treated with Midazolam, Propofol, Sodium Bicarbonate, Norepinephrine, and Intravenous Lipid Emulsion

Acute Hydroxychloroquine Overdose

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