II. Mechanism
- Quinine is a Class Ia Antiarrhythmic Drug
-
Quinine in Overdose blocks cardiac Sodium channels
- Decreased cardiac inotropy
- Decreased cardiac conduction velocity
-
Quinine in Overdose blocks cardiac Potassium channels
- Repolarization is prolonged
- Other Quinine effects in Overdose
- Anticholinergic Toxicity
- Increased Insulin release
- Ototoxicity
- Ophthalmic toxicity
- Vasodilation
III. Pharmacokinetics
- See Quinine
- Severe toxicity is associated with ingestions >1.5 to 8 grams
IV. Adverse Effects: Toxicity
- Cinchonism (reversible Quinine Toxicity)
- Severe Quinine Toxicity
- Cardiac
- Dysrhythmias
- EKG Abnormalities (e.g. Prolonged QTc, QRS Complex or PR Segment)
- Hypotension
- Miscellaneous
- Retinal ischemia (Retinal edema, Decreased Visual Acuity)
- Hypokalemia
- Hypoglycemia
- Cardiac
V. Labs
VI. Management
- Multidose Activated CharcoalDecontamination
- Start Activated Charcoal 1 g/kg
- Continue with 0.5 g/kg every 6 hours for 24 hours
-
Hypoglycemia
- See Hypoglycemia Management
- Intravenous Dextrose
- Consider Octreotide 50 mcg SQ every 6 hours
-
Wide QRS (>100 ms) with Hypotension
- Sodium Bicarbonate boluses until QRS narrows, hemodynamic stability
- Concurrently manage Hypokalemia (worsens with Sodium Bicarbonate)
-
Prolonged QTc with Torsades de Pointes
- See Torsades de Pointes
- ABC Management
- Defibrillation, overdrive pacing
- Magnesium Sulfate IV
- Disposition
- Admit symptomatic patients
- May discharge asymptomatic patients after 6-12 hours
VII. Resources
- Quinine Toxicity (Life in the Fast Lane)
VIII. References
- Carroll and Yakey (2024) Crit Dec Emerg Med 38(12): 32
- Langford (2003) Br J Clin Pharmacol 56(5):576-8 +PMID: 14651733 [PubMed]
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 37445006 |
| English | CINCHONISM, Cinchonism (disorder), Cinchonism, Cinchonism, NOS |
| Italian | Cinconismo |
| Japanese | キニーネ中毒, ｷﾆｰﾈﾁｭｳﾄﾞｸ |
| German | CHININVERGIFTUNG, Chininvergiftung |
| French | CINCHONISME, Cinchonisme |
| Portuguese | CINCHONISMO, Cinchonismo |
| Czech | Cinchonismus |
| Hungarian | Kinin-mérgezés |
| Spanish | cinconismo (trastorno), cinconismo, Cinconismo |
| Dutch | cinchonisme |
Ontology: Poisoning by quinine (C0274477)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 74524003 |
| English | quinine toxicity (diagnosis), quinine toxicity, toxicity from quinine, Poisoning by quinine, Quinine poisoning, Poisoning by quinine (disorder) |
| Spanish | intoxicación por quinina (trastorno), intoxicación por quinina |
Ontology: Quinine intoxication (C0542170)
| Concepts | Injury or Poisoning (T037) |
| Dutch | kininevergiftiging |
| French | Intoxication à la quinine |
| German | Chininintoxikation |
| Italian | Intossicazione da chinino |
| Portuguese | Intoxicação por quinina |
| Spanish | Intoxicación por quinina |
| Japanese | キニーネ中毒, ｷﾆｰﾈﾁｭｳﾄﾞｸ |
| Czech | Intoxikace chininem |
| English | Quinine intoxication |
| Hungarian | Kinin intoxicatio |
Ontology: Quinine overdose (C0573435)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 296565008 |
| English | Quinine overdose, Quinine overdose (disorder) |
| Spanish | sobredosis de quinina (trastorno), sobredosis de quinina |
