Treatment of hydroxychloroquine overdose
Treatment of hydroxychloroquine overdose
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DOI：
10.1053/ajem.2001.25774
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发表时间：
2001-09-01
影响因子：
3.6
通讯作者：
Albertson, TE
中科院分区：
文献类型：
--
作者：
Marquardt, K;Albertson, TE
羟氯喹过量很少报告，在英语医学文献中发现了7例既往病例。我们报告一病例并回顾文献。一名16岁女孩在就诊前30分钟摄入少量羟氯喹200 mg，出现心动过速（心率110次/min）、低血压（收缩压63 mm Hg）、中枢神经系统抑制、传导缺陷（QRS=0.14 msec）和低钾血症（K=2.1 meq/L）。她接受了液体推注和多巴胺、氧气和钾补充剂治疗。毒理学试验证实了羟氯喹的存在。患者的低血压在4.5小时内消退，血清钾在24小时内稳定，心动过速在3天内逐渐减少。虽然羟氯喹过量非常罕见，但在摄入后30分钟内可能发生危及生命的低血压、传导问题和低钾血症。症状与氯喹相似，治疗必须迅速实施，并应根据氯喹过量的经验进行建模。治疗方式需要进一步研究，但目前的建议是：（1）安定癫痫发作和镇静;（2）早期插管和机械通气;（3）肾上腺素治疗血管扩张和心肌抑制;（4）钾替代与密切监测水平;（5）如果在一小时内发生摄入，则用木炭进行胃肠道去污;（6）高剂量地西泮治疗危及生命的症状，直到获得更多信息。没有发现血清碱化或体外药物清除方法的价值。(Am急诊医学杂志2001;19：420-424. Copyright（C）2001 by W.B.桑德斯公司）。
Hydroxychloroquine overdoses are rarely reported with 7 previous cases found in the English medical literature. We report a case and review the literature. A 16-year-old girl ingested a handful of hydroxychloroquine 200mg, 30 minutes before presentation and presented with tachycardia (heart rate 110 beats/min), hypotension (systolic blood pressure 63 mm Hg), central nervous system depression, conduction defects (QRS=0.14 msec), and hypokalemia (K=2.1 meq/L). She was treated with fluid boluses and dopamine, oxygen, and potassium supplementation. Toxicologic tests confirmed the presence of hydroxychloroquine. The patient's hypotension resolved within 4.5 hours, serum potassium stabilized in 24 hours, and tachycardia gradually decreased over 3 days. Although hydroxychloroquine overdoses are very rare, life-threatening hypotension, conduction problems, and hypokalemia can occur within 30 minutes of ingestion. Symptoms are similar to chloroquine and treatment must be implemented quickly and should be modeled after experience with chloroquine overdoses. Treatment modalities need further study, but current recommendations are: (1) diazepam for seizures and sedation; (2) early intubation and mechanical ventilation; (3) epinephrine for treatment of vasodilation and myocardial depression; (4) potassium replacement with close monitoring of levels; (5) charcoal for gastrointestinal decontamination if ingestion occurred within an hour; (6) high dose diazepam for life-threatening symptoms, until more information becomes available. No value was found for serum alkalinization or extracorporeal methods of drug removal. (Am J Emerg Med 2001;19: 420-424. Copyright (C) 2001 by W.B. Saunders Company).