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Case Reports
. 2022 Dec 19;14(12):e32706.
doi: 10.7759/cureus.32706. eCollection 2022 Dec.

Quinine Water-Triggered Atrial Tachyarrhythmia

Emad Elmusa  1 , Hannan Asghar  1 , Ameer Hamza  1 , Muhammad Waleed Raza  1 , Ismael Rodriguez  1
Affiliations
Case Reports

Quinine Water-Triggered Atrial Tachyarrhythmia

Emad Elmusa et al. Cureus. .

Abstract

Quinine is an anti-malarial drug with documented hematologic, dermatologic, and cardiovascular side effects. Tonic water contains a sub-therapeutic amount of quinine and is available over the counter. However, the public is unaware of the risks associated with excessive consumption of tonic water. We present a patient who developed atrial flutter with a rapid ventricular response following the consumption of tonic water. The patient responded to rate control therapy and was discharged the following day with a plan to follow up in the outpatient department with an electrophysiologist. Although quinine has been shown to have ventricular anti-arrhythmic effects, its effect on the atria has not been determined. We present this case to bring greater awareness to the cardiovascular risks associated with the consumption of tonic water to reduce morbidity and mortality.

Keywords: atrial flutter; atrial flutter with rapid ventricular response; atrial tachyarrhythmia; quinine; tachyarrhythmia; tonic water.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Normal appearing chest X-ray
Figure 2
Figure 2. Atrial flutter with 2:1 AV conduction and a heart rate of 128 beats per minute
AV: atrioventricular
Figure 3
Figure 3. Atrial flutter with 4:1 AV conduction and a heart rate of 63 beats per minute
AV: atrioventricular
See this image and copyright information in PMC

References

    1. Antiarrhythmic activity of quinine in humans. Sheldon R, Duff H, Koshman ML. Circulation. 1995;92:2944–2950. - PubMed
    1. Quinine-induced immune thrombocytopenia associated with hemolytic uremic syndrome: a new clinical entity. Gottschall JL, Elliot W, Lianos E, McFarland JG, Wolfmeyer K, Aster RH. https://doi.org/10.1182/blood.V77.2.306.306. Blood. 1991;77:306–310. - PubMed
    1. Fatal hemoglobinuria with uremia from quinine in early pregnancy. Terplan KL, Javert CT. https://doi.org/10.1001/jama.1936.02770070025009 JAMA. 1936;106:529–532.
    1. Quinine-mediated disseminated intravascular coagulation. Kedia RK, Wright AJ. Postgrad Med J. 1999;75:429–430. - PMC - PubMed
    1. Characterization of multiple quinine-dependent antibodies in a patient with episodic hemolytic uremic syndrome and immune agranulocytosis. Stroncek DF, Vercellotti GM, Hammerschmidt DE, Christie DJ, Shankar RA, Jacob HS. https://doi.org/10.1182/blood.V80.1.241.241. Blood. 1992;80:241–248. - PubMed

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