BACKGROUND: High concentrations of quinine, the drug of choice for severe malaria, are toxic to the cardiovascular system, producing hypotension and abnormal myocardial conduction. CASE REPORTS: Five children, aged 14 months to 13 years, were admitted because of fever that appeared a few days after their return from an area in which malaria was endemic. Examination of a thick blood film showed Plasmodium falciparum. They were given quinine intravenously. Four children developed a seizure that recurred in three of them; the fifth child suffered from headache, buzzing in the ears and vision anomalies. Four children rapidly developed hypotension followed by cardiac arrest. All children had abnormal ECG. Retrospective study of the instructions given for quinine administration showed that they were inexplicit and were responsible for incorrect dilution of the drug. Four of the five children recovered completely. The fifth child developed ventricular tachycardia followed by bradycardia that did not respond to resuscitation. CONCLUSION: Major errors can be made in prescribing intravenous quinine. This type of treatment must be carefully monitored and is only indicated in severe forms of malaria, which our patients were not suffering from.
BACKGROUND: High concentrations of quinine, the drug of choice for severe malaria, are toxic to the cardiovascular system, producing hypotension and abnormal myocardial conduction. CASE REPORTS: Five children, aged 14 months to 13 years, were admitted because of fever that appeared a few days after their return from an area in which malaria was endemic. Examination of a thick blood film showed Plasmodium falciparum. They were given quinine intravenously. Four children developed a seizure that recurred in three of them; the fifth child suffered from headache, buzzing in the ears and vision anomalies. Four children rapidly developed hypotension followed by cardiac arrest. All children had abnormal ECG. Retrospective study of the instructions given for quinine administration showed that they were inexplicit and were responsible for incorrect dilution of the drug. Four of the five children recovered completely. The fifth child developed ventricular tachycardia followed by bradycardia that did not respond to resuscitation. CONCLUSION: Major errors can be made in prescribing intravenous quinine. This type of treatment must be carefully monitored and is only indicated in severe forms of malaria, which our patients were not suffering from.