@article{ref1,
title="Toxicokinetics of hydroxychloroquine following a massive overdose",
journal="American journal of emergency medicine",
year="2019",
author="de Olano, Jonathan and Howland, Mary Ann and Su, Mark K. and Hoffman, Robert S. and Biary, Rana",
volume="ePub",
number="ePub",
pages="158387-158387",
abstract="BACKGROUND: We report a patient with a massive hydroxychloroquine overdose manifested by profound hypokalemia and ventricular dysrhythmias and describe hydroxychloroquine toxicokinetics. CASE REPORT: A 20-year-old woman (60 kg) presented 1 h after ingesting 36 g of hydroxychloroquine. Vital signs were: BP, 66 mmHg/palpation; heart rate, 115/min; respirations 18/min; oxygen saturation, 100% on room air. She was immediately given intravenous fluids and intubated. Infusions of diazepam and epinephrine were started. Activated charcoal was administered. Her initial serum potassium of 5.3 mEq/L decreased to 2.1 mEq/L 1 h later. The presenting electrocardiogram (ECG) showed sinus tachycardia at 119 beats/min with a QRS duration of 146 ms, and a QT interval of 400 ms (Bazett's QTc 563 ms). She had four episodes of ventricular tachydysrhythmias requiring cardioversion, electrolyte repletion, and lidocaine infusion. Her blood hydroxychloroquine concentration peaked at 28,000 ng/mL (therapeutic range 500-2000 ng/mL). Serial concentrations demonstrated apparent first-order elimination with a half-life of 11.6 h. She was extubated on hospital day three and had a full recovery. <br><br>CONCLUSION: We present a massive hydroxychloroquine overdose treated with early intubation, activated charcoal, epinephrine, high dose diazepam, aggressive electrolyte repletion, and lidocaine. The apparent 11.6 hour half-life of hydroxychloroquine was shorter than previously described.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0735-6757",
doi="10.1016/j.ajem.2019.158387",
url="http://dx.doi.org/10.1016/j.ajem.2019.158387"
}