Treatment of Severe Chloroquine Poisoning

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Abstract
No therapy has been proved to be effective for patients with severe chloroquine poisoning, which is usually fatal. In a retrospective study of 51 cases, we found that ingestion of more than 5 g of chloroquine was an accurate predictor of a fatal outcome, and therefore chose this dose as the criterion for severe chloroquine poisoning. We selected as a control group 11 consecutive patients who had ingested more than 5 g of chloroquine between July 1983 and December 1985. We then undertook a prospective study to determine whether a better outcome could be obtained with immediate mechanical ventilation and the administration of diazepam and epinephrine. Eleven consecutive patients who ingested more than 5 g of chloroquine in 1986 received this combination therapy. Ten of these patients survived, whereas only one control had survived (P = 0.0003). There was no significant difference between the combination-therapy and control groups in age (29±3 vs. 27±2 years), amount of chloroquine ingested (7.5±0.5 vs. 8.5±0.8 g), systolic arterial pressure (74±2 vs. 74±3 mm Hg), or QRS duration (0.14±0.01 vs. 0.14±0.01 second). In our combination-therapy group, blood chloroquine levels ranged from 40 to 80 μmol per liter, whereas a literature search showed that no patient in whom blood levels were more than 25 μmol per liter had survived.

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