Fatal chloroquine intoxication

Keller, Thomas; Schneider, Andrea; Lamprecht, Robert; Aderjan, R.; Tutsch-Bauer, Edith; Kisser, W

doi:10.1016/s0379-0738(98)00105-4

Cited by 20 publications

(10 citation statements)

References 42 publications

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“…A later study found post‐mortem femoral blood : ante‐mortem serum concentrations of amitriptyline in poisoned patients to be 3.6, 4.3 and 12; and of imipramine to be 3.0 and 6.0 [6]. For chloroquine, the ratio between ante‐mortem serum concentration and post‐mortem peripheral blood concentration was 0.7, whereas the ratio between post‐mortem heart blood and peripheral blood concentrations was 2.9 [67]. Elliott found ratios to be between 1.1 and 6.6 for 3,4‐methylenedioxymetamphetamine (‘ecstasy’) and 1.5 and 13.3 for its metabolite 3,4‐methylenedioxyamphetamine [68].…”

Section: Quantitative Post‐mortem Analysismentioning

confidence: 96%

Post‐mortem clinical pharmacology

Ferner

2008

Brit J Clinical Pharma

163

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Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of 'lethal concentrations' are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements.

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Section: Quantitative Post‐mortem Analysismentioning

confidence: 96%

Post‐mortem clinical pharmacology

Ferner

2008

Brit J Clinical Pharma

163

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“…Overdose of chloroquine and hydroxychloroquine has been a clinical challenge for decades, with cases of poisoning first reported in the 1950s [145,146]. Often chloroquine has been used in these self-poisoning attempts [147][148][149][150][151][152][153][154][155][156] or as an abortifacient [157], particularly in developing countries [158], due to its narrow therapeutic index. One case series from Zimbabwe [158] reported 80% of chloroquine overdoses were deliberate with a nearly 6% mortality rate that was significantly higher than poisonings from other drugs.…”

Section: Toxicity In Overdosementioning

confidence: 99%

Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose

Doyno

Sobieraj

Baker

2020

Clinical Toxicology

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Introduction: While chloroquine, a derivative of quinine, has been used as an antimalarial for 70 years, hydroxychloroquine is now used to treat conditions such as rheumatoid arthritis and systemic lupus erythematosus. In 2020, hydroxychloroquine (and to a lesser extent chloroquine) also received attention as a possible treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During investigation for treating coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, concerns for serious adverse events arose. Objective: We review the toxicity associated with hydroxychloroquine and chloroquine use both short-term and long-term and in overdose. Methods: Medline (via OVID) was searched from its inception through June 7 2020 using the following as either MeSH or keyword terms: ("Chloroquine/" or "Hydroxychloroquine/") AND ("Adverse Drug Event/" or "Toxicities, Drug/" or "Toxic.mp." or "Toxicity.mp." or "Overdose.mp."). We limited resultant articles to those published in English and reporting on Human subjects. This search yielded 330 articles, of which 57 were included. Articles were excluded due to lack of relevance, not reporting desired outcomes, or being duplicative in their content. Twenty-five additional articles were identified through screening references of included articles. To identify toxicities in individuals treated with hydroxychloroquine or chloroquine with COVID-19, we searched PubMed on June 10th, 2020: ("Chloroquine" or "Hydroxychloroquine") AND ("Coronavirus" or "COVID-19" or "SARS-CoV-2"). This search resulted in 638 articles. We reviewed articles for reporting of adverse events or toxicities. Most citations were excluded because they did not include original investigations or extrapolated data from subjects that did not have COVID-19; 34 citations were relevant. For the drug-interactions section, relevant classes and agents were identified through a screen of the https://www.covid19-druginteractions. org/ website. We then conducted targeted searches of PubMed up to June 7th 2020 combining "chloroquine" and "hydroxychloroquine" with terms for specific drug classes and drugs identified from the drug-interaction site as potentially relevant. We found 29 relevant articles. Toxicity with short-term use: Gastrointestinal: Gastrointestinal toxicities are the most common to occur following initiation of chloroquine or hydroxychloroquine. Nausea, vomiting, and diarrhea account for most reported intolerances. Glucose abnormalities: Alterations in blood glucose concentrations may occur with hydroxychloroquine but are rare with standard therapeutic use. Cardiotoxicity: Short-term use can produce conduction abnormalities. Evidence from COVID-19 treatment suggests QT/QTc prolongation is of concern, particularly when used in combination with azithromycin, although disagreement exists across studies. Dermatologic: Drug eruptions or rashes, followed by cutaneous hyperpigmentation, pruritis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, may occur within days to weeks of exposure but ...

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“…The IMS technique permits the simple, rapid determination of these compounds and is successfully used in a number of different fields including security [3], military use [4], petrochemical [5] and environmental analysis [6] as well as diagnostics [7,8], process control [9] and air pollution control [10]. Ion mobility spectrometers can be used as individual units or coupled with separation techniques (GC [11] or HPLC [12]) for the analysis of complex mixtures or as a separation technique for mass spectrometry [13].…”

Section: Introductionmentioning

confidence: 99%

Ion mobility spectra of cyclic and aliphatic hydrocarbons with different substituents

Borsdorf

Neitsch

2009

Int. J. Ion Mobil. Spec.

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We investigated the influence of structural differences on the ionization pathways and drift behavior in ion mobility spectrometry for cyclic and aliphatic hydrocarbons with different functional groups. The sets of cyclic and aliphatic compounds had an identical mass or a mass difference of 2 Da. Therefore, mass effects can be neglected during the investigation of these compounds. Depending on the functional group, considerable differences were found in the detectable concentration ranges and in the number and position of product ion peaks in ion mobility spectra. The spectra of chlorinated compounds and hydrocarbons show no correlation to their calculated collisional cross sections. Differences in collisional cross section between cyclic and aliphatic substances investigated were only found to influence the drift times detected for amines and aliphatic aldehydes while complex ion chemistry was observed for the other substances.

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Fatal chloroquine intoxication

Cited by 20 publications

References 42 publications

Post‐mortem clinical pharmacology

Post‐mortem clinical pharmacology

Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose

Ion mobility spectra of cyclic and aliphatic hydrocarbons with different substituents

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