Michael R Grazier1, Patil Armenian2, Rais Vohra3. 1. University of California San Francisco-Fresno, CA, USA. 2. University of California San Francisco-Fresno, CA, USA parmenian@fresno.ucsf.edu. 3. California Poison Control System-Fresno/Madera Division, Madera, CA, USA.
Abstract
OBJECTIVE: To report a case of life-threatening cinchonism from illicit purchase of chloroquine and survey local ethnic markets to determine what medications are sold without a prescription. CASE REPORT: A 44-year-old Hmong woman presented with abdominal pain and vomiting 30 minutes after ingesting 20 presumed acetaminophen pills in a self-harm gesture. Initial vital signs were normal, and an electrocardiogram (ECG) showed normal sinus rhythm, QRS = 130 ms, and QTc = 455 ms. Her systolic blood pressure dropped to 84 mm Hg, which was unchanged after 3 L normal saline, but improved after 150 mEq NaHCO3. A repeat ECG showed QRS = 114 ms and QTc = 588 ms. Serum labs were significant for K 2.8 mmol/L and Mg 1.8 mg/dL; 2.5 hours later, the family brought in the medication, which was 250 mg tablets of chloroquine phosphate. K and Mg were repleted, and she was admitted to the intensive care unit with complete recovery. Serum chloroquine level 9 hours after ingestion was 530 ng/mL (therapeutic = 20-400 ng/mL). METHODS: We identified local ethnic markets through patient and hospital employee referrals and Internet searches. RESULTS: In our survey, 3 of 4 ethnic markets sold prescription medications: 35 were identified, of which 5 are discontinued by the FDA (diphenidol, phenacetin, metamizole, phenylbutazone, and sibutramine). CONCLUSIONS: A variety of prescription medications, including 5 discontinued by the FDA, were available in markets serving our community's ethnic minorities. Health care workers should be aware of this public health risk, which can result in serious toxicity, as described in this case of chloroquine overdose.
OBJECTIVE: To report a case of life-threatening cinchonism from illicit purchase of chloroquine and survey local ethnic markets to determine what medications are sold without a prescription. CASE REPORT: A 44-year-old Hmong woman presented with abdominal pain and vomiting 30 minutes after ingesting 20 presumed acetaminophen pills in a self-harm gesture. Initial vital signs were normal, and an electrocardiogram (ECG) showed normal sinus rhythm, QRS = 130 ms, and QTc = 455 ms. Her systolic blood pressure dropped to 84 mm Hg, which was unchanged after 3 L normal saline, but improved after 150 mEq NaHCO3. A repeat ECG showed QRS = 114 ms and QTc = 588 ms. Serum labs were significant for K 2.8 mmol/L and Mg 1.8 mg/dL; 2.5 hours later, the family brought in the medication, which was 250 mg tablets of chloroquine phosphate. K and Mg were repleted, and she was admitted to the intensive care unit with complete recovery. Serum chloroquine level 9 hours after ingestion was 530 ng/mL (therapeutic = 20-400 ng/mL). METHODS: We identified local ethnic markets through patient and hospital employee referrals and Internet searches. RESULTS: In our survey, 3 of 4 ethnic markets sold prescription medications: 35 were identified, of which 5 are discontinued by the FDA (diphenidol, phenacetin, metamizole, phenylbutazone, and sibutramine). CONCLUSIONS: A variety of prescription medications, including 5 discontinued by the FDA, were available in markets serving our community's ethnic minorities. Health care workers should be aware of this public health risk, which can result in serious toxicity, as described in this case of chloroquineoverdose.