Presentation
Normal arteriolar caliber may be initially present, but funduscopic manifestations such as vessel attenuation and disc pallor may develop as clinical improvement occurs. [accessemergencymedicine.mhmedical.com]
Gastrointestinal
- Abdominal Pain
pain are also described.51,67,86 Quinine toxicity is closely correlated with total serum concentrations, but only the non protein bound portion is likely responsible for toxic effects. [accessemergencymedicine.mhmedical.com]
Skin
- Erythema
Rare events such as hypersensitivity reactions reported with prophylaxis include urticaria, alopecia, erythema multiforme, toxic epidermal necrolysis, myalgias, mouth ulcers, neutropenia, and thrombocytopenia.72,83,103,108 It is unclear which, if any, [accessemergencymedicine.mhmedical.com]
- Alopecia
Rare events such as hypersensitivity reactions reported with prophylaxis include urticaria, alopecia, erythema multiforme, toxic epidermal necrolysis, myalgias, mouth ulcers, neutropenia, and thrombocytopenia.72,83,103,108 It is unclear which, if any, [accessemergencymedicine.mhmedical.com]
Musculoskeletal
- Muscle Cramp
Additionally, because of a reported curarelike action, quinine has also been used as a treatment for muscle cramps. Because of its extremely bitter taste similar to that of heroin, quinine is used as an adulterant in drugs of abuse. [accessemergencymedicine.mhmedical.com]
Neurologic
- Agitation
Other neuropsychiatric symptoms include dysphoria, altered consciousness, encephalopathy, anxiety, depression, giddiness, and agitated delirium with psychosis. [accessemergencymedicine.mhmedical.com]
- Insomnia
During prophylactic use, 10% to 40% of patients experience insomnia and bizarre or vivid dreams and complain of dizziness, headache, fatigue, mood alteration, and vertigo.103,122 Only 2% to 10% of these complications necessitate the traveler to seek medical [accessemergencymedicine.mhmedical.com]
- Ataxia
[…] with psychotropics.114 Women appear to be more likely than men to experience neuropsychiatric adverse effects.114,122 The risk of serious neuropsychiatric adverse effects (convulsions, altered mental status, inability to ambulate because of vertigo or ataxia [accessemergencymedicine.mhmedical.com]
- Convulsions
[…] previous mefloquine-related neuropsychiatric adverse effects, and previous treatment with psychotropics.114 Women appear to be more likely than men to experience neuropsychiatric adverse effects.114,122 The risk of serious neuropsychiatric adverse effects (convulsions [accessemergencymedicine.mhmedical.com]
Workup
Rhythm
- Torsades De Pointes
Bradycardia is commonly reported.25,67,83 With prophylactic use, neither the PR interval nor the QRS complex is prolonged, but QT prolongation is reported.34,67 Reports of torsade de pointes are rare, but the increase in QT and risk of torsade de pointes [accessemergencymedicine.mhmedical.com]
Treatment
As early as 1633, cinchona bark was used for its antipyretic and analgesic effects,76 and in the 1800s, it was used for the treatment of “rebellious palpitations.”117 Quinine, the primary alkaloid in cinchona bark, was the first effective treatment for [accessemergencymedicine.mhmedical.com]
Pathophysiology
Pathophysiology. Quinine overdose affects multiple organ systems through a number of different pathophysiologic mechanisms. Studies evaluating mechanisms of toxicity have focused on those organ systems primarily affected. [accessemergencymedicine.mhmedical.com]