Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians
Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. This review describes acute chloroquine and hydroxychloroquine tox...
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| Veröffentlicht in: | The American journal of emergency medicine 2020-10, Vol.38 (10), p.2209-2217 |
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| creator | Della Porta, Alessandra Bornstein, Kasha Coye, Austin Montrief, Tim Long, Brit Parris, Mehruba Anwar |
| description | Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality.
This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.
Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.
An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease. |
| doi_str_mv | 10.1016/j.ajem.2020.07.030 |
| format | Article |
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This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.
Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.
An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2020.07.030</identifier><identifier>PMID: 33071096</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute toxicity ; Aminoquinoline ; Autoimmune diseases ; Chloroquine ; Chloroquine - pharmacokinetics ; Chloroquine - pharmacology ; Chloroquine - poisoning ; Clinical trials ; Coronaviruses ; COVID-19 ; COVID-19 - drug therapy ; Decontamination ; Drug Overdose - therapy ; Emergency medical care ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Hydroxychloroquine ; Hydroxychloroquine - pharmacokinetics ; Hydroxychloroquine - pharmacology ; Hydroxychloroquine - poisoning ; Malaria ; Morbidity ; Mortality ; Pandemics ; Pathophysiology ; Prophylaxis ; Rheumatoid arthritis ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Systemic lupus erythematosus ; Toxicity ; Vector-borne diseases</subject><ispartof>The American journal of emergency medicine, 2020-10, Vol.38 (10), p.2209-2217</ispartof><rights>2020</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Oct 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-7a969feb262ed0e3a64e3c8214ef407ad9b951112b71d66975d25f3b2ccb84b73</citedby><cites>FETCH-LOGICAL-c483t-7a969feb262ed0e3a64e3c8214ef407ad9b951112b71d66975d25f3b2ccb84b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675720306252$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33071096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Della Porta, Alessandra</creatorcontrib><creatorcontrib>Bornstein, Kasha</creatorcontrib><creatorcontrib>Coye, Austin</creatorcontrib><creatorcontrib>Montrief, Tim</creatorcontrib><creatorcontrib>Long, Brit</creatorcontrib><creatorcontrib>Parris, Mehruba Anwar</creatorcontrib><title>Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality.
This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.
Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.
An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.</description><subject>Acute toxicity</subject><subject>Aminoquinoline</subject><subject>Autoimmune diseases</subject><subject>Chloroquine</subject><subject>Chloroquine - pharmacokinetics</subject><subject>Chloroquine - pharmacology</subject><subject>Chloroquine - poisoning</subject><subject>Clinical trials</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - drug therapy</subject><subject>Decontamination</subject><subject>Drug Overdose - therapy</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hydroxychloroquine</subject><subject>Hydroxychloroquine - pharmacokinetics</subject><subject>Hydroxychloroquine - pharmacology</subject><subject>Hydroxychloroquine - poisoning</subject><subject>Malaria</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Pathophysiology</subject><subject>Prophylaxis</subject><subject>Rheumatoid arthritis</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Systemic lupus erythematosus</subject><subject>Toxicity</subject><subject>Vector-borne diseases</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU9r3DAQxUVpabZJv0APxdCz3RlJltalFJbQfxDoJTkLWRpnZXatVPYm8bePzKYhufQkGP3mzcx7jH1AqBBQfe4r29O-4sChAl2BgFdshbXg5Ro1vmYr0KIula71CXs3jj0AoqzlW3YiBGiERq3Y5cYdJircdhdT_HsIAxV28MV29inez8_LU7wPLkzzl2JTJLoNdFd0MRW0p3RNg5sLtwtDJuwwnrE3nd2N9P7xPWVXP75fnv8qL_78_H2-uSidXIup1LZRTUctV5w8kLBKknBrjpI6Cdr6pm1qROStRq9Uo2vP60603Ll2LVstTtm3o-7Nod2TdzRMye7MTQp7m2YTbTAvf4awNdfx1mihGlQ8C3x6FFiupHEyfTykIe9suFQSFfBmofiRcimOY6LuaQKCWZIwvVmSMEsSBrTJSeSmj893e2r5Z30Gvh4Byg5lO5MZXchGkg-J3GR8DP_TfwATMpwc</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Della Porta, Alessandra</creator><creator>Bornstein, Kasha</creator><creator>Coye, Austin</creator><creator>Montrief, Tim</creator><creator>Long, Brit</creator><creator>Parris, Mehruba Anwar</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>W B Saunders</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>5PM</scope></search><sort><creationdate>20201001</creationdate><title>Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians</title><author>Della Porta, Alessandra ; 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This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.
Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.
An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33071096</pmid><doi>10.1016/j.ajem.2020.07.030</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute toxicity Aminoquinoline Autoimmune diseases Chloroquine Chloroquine - pharmacokinetics Chloroquine - pharmacology Chloroquine - poisoning Clinical trials Coronaviruses COVID-19 COVID-19 - drug therapy Decontamination Drug Overdose - therapy Emergency medical care Emergency Service, Hospital Hemodynamics Humans Hydroxychloroquine Hydroxychloroquine - pharmacokinetics Hydroxychloroquine - pharmacology Hydroxychloroquine - poisoning Malaria Morbidity Mortality Pandemics Pathophysiology Prophylaxis Rheumatoid arthritis SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Systemic lupus erythematosus Toxicity Vector-borne diseases |
| title | Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians |
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