Treatment of antimalarial poisoning
7.1 General treatment
When it is found that poisoning is caused by overdose of antimalarial drugs, the drug should be stopped immediately and the following treatments should be taken.
7.1.1 The general management of antimalarial overdose includes gastric lavage and symptomatic treatment.
7.1.2 Chloroquine and quinine overdose require early monitoring of vital signs. ECG, blood pressure and intensive supportive treatment of cardiovascular disturbances: adrenaline (epinephrine) for circulatory arrest, isoprenaline (isoproterenol) for shock and conduction disturbances. Direct current counter shock for ventricular tachycardia or fibrillation and sometimes pacemarker stimulation for later ventricular arrhythmania.
7.1.3 Experimental and clinical data have shown that diazepam may reverse chloroquine cardiotoxicity. After ingestion of a large dose or when cardiotoxic symptoms are present, diazepam should be given systematically as a loading dose of 1 mg/ kg followed by a continuous infusion.
7.1.4 Methaemoglobinaemia requires methylene blue administration and repeated oral doses of activated charcoal. Haemodialysis may be indicated if methaemoglobinaemia recurs.
7.1.5 Chloroquine overdose remains the most severe and frequent cause of antimalarial drug poisonings. Its prognosis and high mortality should be improved by adequate supportive treatment and by the systematic and early treatment with diazepam.
7.2 Treatment of chloroquine toxicity
The distance between efficacy and doxicity of chloroquine is relatively narrow. Clinical symptoms of chloroquine poisoning may be divided into 3 categories: neurological, respiratory and cardiovascular, such as dizziness, heart rate, shortness of breath, pallor, cyanosis, cold sweat, difficulty in speaking, convulsions, coma and respiratory depression. A new treatment for chloroquine poisoning combines early mechnical ventilation with the administration of diazepam and epinephrine. The following measures can be taken to deal with the symptoms as appropriate.
7.2.1 Use epinephrine 1-2 mg, dissolved in 5% glucose 250-500 mL solution, intravenous infusion or sublingual administered 10 mg, once every 2-4 hours.
7.2.2 Appropriate use of diazepam: Diazepam has been demonstrated experimentally to decrease mortality due to chloroquine poisoning.
7.2.3 Oxygen and endotracheal intubation.
7.2.4 Symptomatic treatment.
7.3 Treatment of primaquine poisoning
For patients with glucose-6-phosphate dehydrogenase deficiency it can cause serious side effects after taking primaquine, and there is no specific antidote for acute poisoning caused by overdose of primaquine. As a consequence, the following measures can be taken to deal with the symptoms as appropriate:
7.3.1 Toxic reactions of primaquine include dizziness, chest tightness, palpitation and shortness of breath. The drug should be stopped immediately and methylene blue (1-2 mg/kg bw) should be given slowly with intravenous infusion after dissolved in glucose solution. Methylene blue can also be taken orally, 150-300 mg per day.
7.3.2 When hemoglobinuria occurs, the drug should be stopped immediately and let the patient stay in bed, rest. Corticosteroids, such as hydrocortisone (100-300 mg) dissolved in glucose solution, should be given intravenously once every 4 to 6 hours to reduce hemolysis and improve microcirculation. If hemolysis is serious, blood transfusion is necessary.(https://www.daowen.com)
7.3.3 Symptomatic treatment.
7.4 Treatment of quinine poisoning
At present, China does not recommend quinine for the treatment of malaria. If quinine poisoning occurs, treatments can be used as follows:
7.4.1 The solution of hypertonic sodium sulfate shall be added to the liquid of gastric lavage to accelerate the excretion of unabsorbed drugs.
7.4.2 Blood pressure must be maintained and symptomatic treatment must be taken to protect renal function and reduce the inhibition of central nervous system.
7.4.3 Respiratory stimulants can be used in patients with respiratory failure, such as 3-6 mg of lobeline intravenous infusion, or 375 mg of nikethamide, once every 10 to 20 minutes, or 8 mg of dimethylverine intravenous infusion. Caffeine, ephedrine and oxygen inhalation can be used as appropriate.
7.4.4 If angioneurotic edema or asthma occurs, the administration of inotropic agents, isoprenaline (isoproterenol), dopamine and hormones will be the drugs of choice.
7.4.5 Once visual impairment occurs, vasodilators such as nitrite and methacholine may be effective.
7.4.6 If hemoglobinuria occurs, it can refer to primaquine poisoning treatment.
7.5 Treatment of artemisinin poisoning
Artemisinin drugs have a wide distance between efficacy and toxicity and are generally not susceptible to poisoning. However, people who are allergic to artemisinin drugs may have symptoms such as rash, itching, shortness of breath, swelling of face, lips or tongue, muscle pain or joint pain, or even more serious consequences. Take the following treatment measures.
7.5.1 Stop medication immediately and stay in bed, rest.7.5.2 Gastric lavage or enema.
7.5.3 Appropriate intravenous infusion.
7.5.4 Appropriate use of hormones.
7.5.5 Symptomatic treatment.
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