Mini Episode: Managing Crashing Hydroxychloroquine/Chloroquine OD

The Poison Lab

Quick review

• Toxic dose
  • Chloroquine >5g severe toxicity is expected (toxicity may develop below this)
  • HCQ less well defind
• Clinical effects
  • Seizures (sodium channel blockade)
  • Arrhythmia (sodium channel blockade)
  • Hypotension (Alpha blockade)
  • Hypokalemia
• Management
  • Activated Charcoal if awake and alert and no risk of emesis
  • Early invasive supportive care based on the following retrospective case control series https://www.nejm.org/doi/full/10.1056/NEJM198801073180101
    • High dose epinephrine (0.25 mcg/kg/min)
    • Diazepam 1-2 mg/kg over 30 minutes followed by 1-2 mg/kg over 24 hours (seizure prevention)
      • Evidence supports this may be cardio protective as well
    • Early intubation
  • Consultation with poison center recommended 1-800-222-1222