Quinine and the ABCs of Long QT: A Patient’s Misfortune with Arthritis, (Alcoholic) Beverages, and Cramps

Abstract

A 91-year-old woman presented to the emergency department by ambulance after her family found her minimally responsive. Telemetry monitoring demonstrated episodes of non-sustained polymorphic ventricular tachycardia (PMVT) associated with significantly prolonged repolarization. Her medical history revealed that she was taking quinine or a derivative in three different forms: hydroxychloroquine, quinine sulfate (for leg cramps), and her gin mixed with tonic water (containing quinine). The present case is illustrative of classic etiologies and findings of acquired long QT syndrome, and serves as an important reminder for providers to take a complete medication history, including use of duplicative and alternative medicines and type of alcohol consumption.KEY WORDS: cardiac arrhythmia; prolonged QT; quinine; gin and tonic.

Torsade de pointes associated with chloroquine, hydroxychloroquine, and azithromycin: a retrospective analysis of individual case safety reports from VigiBase

“…Disproportionality was observed for TdP and azithromycin in a previous study performed in the US FDA AERS database [16]. Several individually reported cases of TdP included in this study have been described in detail elsewhere [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Eau tonique et quinine – un cocktail de bicentenaire servi en pleine effervescence

“…À notre connaissance, la littérature recense 27 cas publiés entre 1953 et aujourd’hui [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , synthétisés par les Tableau 1 , Tableau 2 , Tableau 3 au regard de la nature des manifestations : dermatologiques, hématologiques, ou autres. Une publication, écrite en langue japonaise, a malheureusement été écartée [45] .…”

“…Amélioration à l’arrêt de la boisson. Quininémie 0,5 mg/L Sheehan, 2016 [44] F, 90 • Quinine pour des crampes et gin tonic chaque soir • Antécédent d’arthrite rhumatoïde, sous hydroxychloroquine • Confusion, défense, après deux semaines de toux, perte d’appétit. Depuis la veille, NVD, contexte viral.…”

“…La gravité des symptômes est variable. Sur les 27 cas, 8 ont engendré une hospitalisation [19] , [20] , [21] , [22] , [23] , [24] , [35] , [44] , sans compter les tests de réintroduction sous surveillance hospitalière. La symptomatologie est essentiellement dermatologique (70 %) – toxidermies surtout de type érythème pigmenté fixe et d’exanthème généralisé, plus rarement des urticaires – ; hématologique, avec des conséquences sévères (19 %) – thrombopénie, syndrome hémorragique localisé ou diffus, microangiopathie thrombotique – ; plus rarement oculaire, cardiaque, et auditive.…”