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Review
. 2020 Oct;38(10):2209-2217.
doi: 10.1016/j.ajem.2020.07.030. Epub 2020 Jul 19.

Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians

Alessandra Della Porta  1 , Kasha Bornstein  1 , Austin Coye  1 , Tim Montrief  1 , Brit Long  2 , Mehruba Anwar Parris  3
Affiliations
Review

Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians

Alessandra Della Porta et al. Am J Emerg Med. 2020 Oct.

Abstract

Background: 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.

Objective: This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.

Discussion: 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.

Conclusions: 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.

Keywords: Acute toxicity; Aminoquinoline; Chloroquine; Hydroxychloroquine.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Fig. 1
Fig. 1
Adult algorithmic management of chloroquine and hydroxychloroquine overdose.
See this image and copyright information in PMC

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