Utility of Hypertonic Saline and Diazepam in COVID-19-Related Hydroxychloroquine Toxicity.
Utility of Hypertonic Saline and Diazepam in COVID-19-Related Hydroxychloroquine Toxicity.
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DOI：
10.1016/j.jemermed.2020.10.048
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Stearns DA
中科院分区：
文献类型：
--
作者：
Mahan KM;Hayes BD;North CM;Becker JS;Fenves AZ;Hyppolite G;Khosrowjerdi S;Sinden D;Stearns DA
羟氯喹 (HCQ) 中毒是一种危及生命但可治疗的有毒物质摄入。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染 (COVID-19) 的规模以及 HCQ 是一种治疗选择这一有争议的建议导致 HCQ 使用量显着增加。在摄入有毒物质的情况下，羟氯喹中毒应该是急救人员首先考虑的问题。 HCQ 中毒的治疗包括碳酸氢钠、肾上腺素和积极补充电解质。我们强调使用高渗盐水和地西泮。我们描述了一名 37 岁男性的病例，他在摄入约 16 克 HCQ 片剂（初始血清浓度 4270 ng/mL）后被送往急诊科。他接受了肾上腺素输注、高渗氯化钠、大剂量地西泮、碳酸氢钠和积极补充钾的治疗。持续改变的精神状态需要插管，他在重症监护病房接受治疗，直到 QRS 增宽和 QTc 延长得到解决。待其精神状态好转并确认其并非出于自残意图后，出院回家并接受门诊随访。对于HCQ过量且初始血清钾水平未知的患者，QRS波增宽的患者应立即开始大剂量地西泮和高渗氯化钠治疗。选择高渗氯化钠而不是碳酸氢钠是为了避免加剧潜在的低钾血症，从而可能加剧不稳定的心律失常。此外，呕吐患者应优先考虑早期插管，因为 HCQ 毒性和大剂量地西泮会导致深度镇静。
Hydroxychloroquine (HCQ) poisoning is a life-threatening but treatable toxic ingestion. The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) and the controversial suggestion that HCQ is a treatment option have led to a significant increase in HCQ use. HCQ poisoning should be at the top-of-mind for emergency providers in cases of toxic ingestion. Treatment for HCQ poisoning includes sodium bicarbonate, epinephrine, and aggressive electrolyte repletion. We highlight the use of hypertonic saline and diazepam. We describe the case of a 37-year-old man who presented to the emergency department after the ingestion of approximately 16 g of HCQ tablets (initial serum concentration 4270 ng/mL). He was treated with an epinephrine infusion, hypertonic sodium chloride, high-dose diazepam, sodium bicarbonate, and aggressive potassium repletion. Persistent altered mental status necessitated intubation, and he was managed in the medical intensive care unit until his QRS widening and QTc prolongation resolved. After his mental status improved and it was confirmed that his ingestion was not with the intent to self-harm, he was discharged home with outpatient follow-up. For patients presenting with HCQ overdose and an unknown initial serum potassium level, high-dose diazepam and hypertonic sodium chloride should be started immediately for the patient with widened QRS. The choice of hypertonic sodium chloride instead of sodium bicarbonate is to avoid exacerbating underlying hypokalemia which may in turn potentiate unstable dysrhythmia. In addition, early intubation should be a priority in vomiting patients because both HCQ toxicity and high-dose diazepam cause profound sedation.
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