• Alessandra Della Porta, Kasha Bornstein, Austin Coye, Tim Montrief, Brit Long, and Mehruba Anwar Parris.
• University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA.
• Am J Emerg Med. 2020 Oct 1; 38 (10): 220922172209-2217.

BackgroundAcute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality.ObjectiveThis review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population.DiscussionChloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10-30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention.ConclusionsAn understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.Published by Elsevier Inc.

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