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2020 ; 4
(1
): 40-42
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Chloroquine, hydroxychloroquine and COVID-19
#MMPMID32457932
Erickson TB
; Chai PR
; Boyer EW
Toxicol Commun
2020[]; 4
(1
): 40-42
PMID32457932
show ga
The media have featured the antimalarials chloroquine (CQ) and hydroxychloroquine
(HCQ) to treat coronavirus (COVID-19). Political leaders have touted their use
and recommended availability to the public. These anti-inflammatory agents have
substantial human toxicity with a narrow therapeutic window. CQ and HCQ poisoning
cause myocardial depression and profound hypotension due to vasodilation.
Bradycardia and ventricular escape rhythms arise from impaired myocardial
automaticity and conductivity due to sodium and potassium channel blockade. With
cardiotoxicity, ECGs may show widened QRS, atrioventricular heart block and QT
interval prolongation. CQ may also cause seizures, often refractory to standard
treatment. Of concern is pediatric poisoning, where 1-2 pills of CQ or HCQ can
cause serious and potentially fatal toxicity in a toddler. The treatment of
CQ/HCQ poisoning includes high-dose intravenous diazepam postulated to have
positive ionotropic and antidysrhythmic properties that may antagonize the
cardiotoxic effects of CQ. Infusions of epinephrine titrated to treat unstable
hypotension, as well as potassium for severe hypokalemia may be required. Current
scientific evidence does not support treatment or prophylactic use of these
agents for COVID-19 disease. Regulatory and public health authorities recognize
that CQ/HCQ may offer little clinical benefit and only add risk requiring further
investigation before wider public distribution.
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