Detoxification with intravenous lipid emulsion for fatal hydroxychloroquine poisoning.

Published on May 4, 2021in Modern Rheumatology2.113
· DOI :10.1080/14397595.2020.1812869
Kanako Noda (Kyoto Prefectural University of Medicine), Shinji Akioka5
Estimated H-index: 5
(Kyoto Prefectural University of Medicine)
+ 1 AuthorsHajime Hosoi33
Estimated H-index: 33
(Kyoto Prefectural University of Medicine)
Hydroxychloroquine (HCQ) is an international-standard ‘anchor’ drug for treatment of systemic lupus erythematosus (SLE). After being approved in Japan half a century later in the Western countries,...
There is currently an increased interest in using the antimalarials chloroquine and hydroxychloroquine for the treatment of other diseases, including cancer and viral infections such as COVID-19. However, risks of cardiotoxic effects tend to limit their use. The effects of these drugs on the electrical and mechanical activities of the heart, as well as on the remodeling of the cardiac tissue are presented, and the underlying molecular and cellular mechanisms discussed. The drugs can have proarrh...
19 CitationsSource
#1Clotilde ChatreH-Index: 2
#2François Roubille (University of Montpellier)H-Index: 24
Last. Yves-Marie Pers (University of Montpellier)H-Index: 21
view all 5 authors...
Introduction Chloroquine and hydroxychloroquine are widely used in the long-term treatment of connective tissue disease and usually considered safe. However, chloroquine- or hydroxychloroquine-related cardiac disorder is a rare but severe adverse event, which can lead to death. This systematic review investigates cardiac complications attributed to chloroquine and hydroxychloroquine.
186 CitationsSource
#1Joseph M. Neal (Virginia Mason Medical Center)H-Index: 47
#2Michael J. Barrington (St. Vincent's Health System)H-Index: 27
Last. Guy L. Weinberg (Cornell University)H-Index: 50
view all 8 authors...
Abstract The American Society of Regional Anesthesia and Pain Medicine9s Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging i...
103 CitationsSource
#1Maria Eugenia Schroeder (Pasteur Institute)H-Index: 2
#2Sofía Russo (Pasteur Institute)H-Index: 3
Last. Marcelo Hill (Pasteur Institute)H-Index: 23
view all 10 authors...
Antimalarials have demonstrated beneficial effects in Systemic Lupus Erithematosus and Rheumatoid Arthritis. However, the mechanisms and the molecular players targeted by these drugs remain obscure. Although hydroxychloroquine (HCQ) is a known ion channel inhibitor, this property has not been linked to its anti-inflammatory effects. We aimed to study whether HCQ inhibits pro-inflammatory ion channels. Electrophysiology experiments demonstrated that HCQ inhibited Ca++-activated K+ conductance in ...
21 CitationsSource
5 CitationsSource
#1Sophie Gosselin (MUHC: McGill University Health Centre)H-Index: 24
#2Lotte C. G. Hoegberg (Copenhagen University Hospital)H-Index: 14
Last. Valery Lavergne (UdeM: Université de Montréal)H-Index: 26
view all 19 authors...
AbstractBackground: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning.Methods: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA po...
63 CitationsSource
This case report describes the possible benefit of intravenous lipid emulsion in two patients surviving a severe intoxication with hydroxychloroquine in a dose that was previously considered to be lethal. The first case involves a 25-year-old female who ingested 17.5 grams of hydroxychloroquine, approximately one hour before presentation. An ECG showed QRS widening and the lab results showed hypokalaemia. She became unconscious, and developed hypotension and eventually apnoea. After intubation, ...
17 Citations
Calcium channel antagonists (CCAs) are widely used for different cardiovascular disorders. At therapeutic doses, CCAs have a favourable side effect profile. However, in overdose, CCAs can cause serious complications, such as severe hypotension and bradycardia. Patients in whom a moderate to severe intoxication is anticipated should be observed in a monitored setting for at least 12 hours if an immediate-release formulation is ingested, and at least 24 hours when a sustainedrelease formulation (o...
16 Citations
#1Paul B. McBeth (UBC: University of British Columbia)H-Index: 23
#2Perseus I. Missirlis (UBC: University of British Columbia)
Last. Vinay Dhingra (UBC: University of British Columbia)H-Index: 14
view all 4 authors...
Introduction. Hydroxychloroquine (HCQ) overdose is rare and potentially deadly when consumed in large doses. Management of severe HCQ toxicity is limited and infrequently reported. This report presents the case of a massive ingestion of HCQ. Case Report. A 23-year-old female presents following an intentional ingestion of approximately 40 g of HCQ. Within six hours after ingestion, she developed severe hemodynamic instability resulting from myocardial irritability with frequent ventricular ectopi...
14 CitationsSource
#1Dazhe Cao (University of Colorado Denver)H-Index: 8
#2Kennon Heard (University of Colorado Denver)H-Index: 34
Last. Alex Koyfman (UTSW: University of Texas Southwestern Medical Center)H-Index: 20
view all 4 authors...
Abstract Background Intravenous lipid emulsion (ILE) has been broadly attempted in the resuscitation of neurologic and cardiac toxic drug overdoses, however, the role of ILE in the emergency department is poorly defined. Objective This review aims to identify recent literature on the use of ILE in humans as an antidote and to familiarize emergency providers with the indications, availability, dosing recommendations, and adverse reactions associated with ILE use. Methods A systemic literature sea...
75 CitationsSource
Cited By1
Dear EditorWe read with interest the case report entitled “Detoxification with intravenous lipid emulsion for fatal hydroxychloroquine poisoning” published recently in Modern Rheumatology [1]. Rece...