Quinine poisoning
Introduction
Introduction to quinine poisoning Quinine poisoning is caused by excessive dosage or specificity. Intravenous injection or excessive concentration of liquid can cause shock. Pregnant women or lactating women use high-dose quinine to cause fetal or neonatal poisoning through the placental barrier or milk. Compound quinine injection contains 0.136 g of quinine hydrochloride and a small amount of caffeine and urethane. It can cause allergic reaction and shock to quinine in children with idiosyncratic constitution. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: headache, deafness, amblyopia, asthma
Cause
Cause of quinine poisoning
Cause:
Quinine is a quinoline derivative that binds to the DNA of Plasmodium to form a complex that inhibits DNA replication and RNA transcription, thereby inhibiting protozoal protein synthesis, which is weaker than chloroquine. In addition, quinine can reduce the oxygen consumption of the malaria parasite, inhibit the phosphorylase in the malaria parasite and interfere with its sugar metabolism. Quinine also causes malaria pigmentation, but it develops slowly, rarely forms large clumps, and is often accompanied by cell death. Observed by electron microscopy, it can be seen that the nucleus and outer membrane of the protozoa are swollen, and there are small vacuoles. The blood cell particles are polymerized in small vacuoles, which is different from the pigmentation of chloroquine. Excessive use of quinine drugs, causing symptoms of poisoning.
Prevention
Quinine poisoning prevention
Strictly follow the use of quinine and the dosage used.
Pregnant women are banned, quinine has an oxytocin effect, this product can pass through the placenta, causing fetal hearing damage and the central nervous system, congenital defects of the limbs, lactating women with caution.
For patients with asthma, atrial fibrillation and other serious heart disease, glucose-6-phosphate dehydrogenase deficiency, myasthenia gravis, patients with optic neuritis should be used with caution.
Cardiomyopathy and pregnant women are banned. It is dangerous to treat cerebral malaria with quinine, and it is dangerous to use this medicine for people who are allergic to quinine.
Complication
Quinine poisoning complications Complications, headache, deafness, amblyopia, asthma
1 quinine daily dosage of more than 1g or long-lasting, often cause cinchona reaction, which is similar to salicylic acid reaction, there are tinnitus, headache, nausea, vomiting, visual hearing loss and other symptoms, severe cases of temporary deafness, It can often be recovered after stopping the drug.
When the dose is 4g in 224 hours, the nerve tissue can be directly damaged and the retinal blood vessels can be contracted, and the visual field is reduced, double vision, amblyopia and the like.
3 large doses of poisoning, in addition to the above-mentioned reaction aggravated, due to inhibition of the myocardium, expansion of peripheral blood vessels caused by sudden drop in blood pressure, breathing slower and shallower, fever, irritability, convulsions, etc., more than respiratory paralysis.
4 quinine lethal dose of about 8g.
5 A small number of patients are highly sensitive to quinine, and a small amount can cause severe cinchona reaction.
6 A small number of falciparum malaria patients can cause acute hemolysis (black urine fever) to death with a small amount of quinine.
7 quinine can also cause rash, itching, asthma and so on.
Symptom
Symptoms of quinine poisoning Common symptoms Diarrhea, abdominal pain, nausea, convulsions, tinnitus, hearing loss, chills, coma, convulsions
Quinine poisoning involves the gastrointestinal tract, nervous system, cardiovascular system, skin, etc., and has a depressing effect on the activity of various enzymes. Auditory and visual impairment are more obvious. The clinical manifestations are mainly headache, dizziness, nausea, vomiting, abdominal pain. , diarrhea, sweating, visual disturbances such as blurred vision, confusion of color vision, photophobia, diplopia, night blindness, dilated pupils, blindness, hearing disorders such as tinnitus, auditory hallucinations, hearing loss, etc., or redness of the skin, rash, Itching, asthma, angioedema, occasionally anaphylactic shock, severe poisoning often chills, elevated or decreased body temperature, arrhythmia, excitement, paralysis, muscle twitching, convulsions, coma, death due to respiratory paralysis and circulatory failure In addition, there may be liver, kidney damage, hemolysis, hypoprothrombinemia, thrombocytopenic purpura and the like.
Examine
Quinine poisoning check
The disease is acute poisoning. After poisoning symptoms, it should be immediately poisoned with 3%-5% citrate solution or 1:2000 potassium permanganate solution for gastric lavage, oral administration of citric acid and 0.5% activated carbon suspension, and parallel catharsis. Wait until the condition is stable before doing routine examinations.
Diagnosis
Diagnosis and diagnosis of quinine poisoning
Differential diagnosis
Identification with other antimalarial drug poisoning, including chloroquine, pyrimethamine poisoning.
Chloroquinolquine clinical manifestations of nausea, vomiting, abdominal pain, diarrhea, headache, dizziness, loss of eye, numbness of the limbs, visual impairment, muscle fibrillation and confusion, hypotension, electrocardiogram can have T wave flat, QT interval prolonged or Increased ST segment can still occur in granulocytes and thrombocytopenia, severe cases can occur coma, shock, respiratory depression and cardiac arrest.
Clinical manifestations usually take 1/2-6 hours after taking the drug, symptoms of nausea, nausea, vomiting, stomach burning, abdominal pain, thirst, dizziness, headache, irritability, blurred vision, palpitations, severe poisoning cases can have high fever, breathing Shortness, convulsions, dilated pupils, rapid coma, and respiratory and circulatory failure.
