Reactions 1476, p20 - 2 Nov 2013

O SHydroxychloroquine/oxycodone/paracetamol overdose

Drowsiness, hypotension and ventricularfibrillation: case report

A 51-year-old woman developed drowsiness, hypotensionand ventricular fibrillation following an overdose ofhydroxychloroquine and oxycodone/paracetamol[acetaminophen].

The woman presented to a rural emergency room withdrowsiness and hypotension (BP 80/44mm Hg) 1–2h afteringesting 60 tablets of hydroxychloroquine 200mg and35 tablets of oxycodone/paracetamol 5/325mg.

The woman was treated with naloxone, epinephrine[adrenaline] and diazepam, and was transferred by helicopterto a tertiary care centre. She developed ventricular fibrillationarrest en route, which resolved with chest compressions. Afterarriving at the tertiary care centre, her systolic BP repeatedlydecreased into the 70’s. Following a bolus of IV fat emulsion(IFE), her BP increased to 115/66mm Hg. Her serumpotassium level was 2.2 mEq/L and an ECG demonstrated largeU waves. A vasopressin infusion was started. Her systolic BPdecreased to 70mm Hg, but resolved following a 30-minuteinfusion of IFE. Vasopressors were gradually discontinuedwithin 9h of initial IFE administration. She was extubated2 days later, and her neurological status was intact.

Author comment: "We report a case ofhydroxychloroquine overdose treated successfully with IFEalong with other standard therapies."Stellpflug SJ, et al. Hydroxychloroquine overdose treated successfully withintravenous fat emulsion. Clinical Toxicology 51: 652, No. 7, Aug 2013. Availablefrom: URL: http://dx.doi.org/10.3109/15563650.2013.817658 [abstract] -USA 803095128

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Reactions 2 Nov 2013 No. 14760114-9954/13/1476-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved