chloroquine induced hypokalemia
TRANSCRIPT
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2CASE PRESENTATION
Dr. Pranesh PawaskarFirst year resident,Dept. of pharmacology,L.T.M.M.C. Sion, Mumbai 400022Date :- 02/12/2016.
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3CHLOROQUINE INDUCED HYPOKALEMIA
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4CASE
• Male
• 35 years
• No h/o any disease or comorbid condition.
• c/o Fever with chills … 7 days.
Generalised body pain … 7 days.
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5COURSE OF REACTION
11/10/2016Patient started getting fever with chills
.
.Fever went on becoming high grade
.12/10/2016
Patient seek treatment from private practitioner
.
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6COURSE OF REACTION
Private practitioner started him on Tab. Chloroquine 500mg B.D. Tab. Paracetamol 500mg T.D.S.Tab. Pantoprazole 20mg B.D.
.
.
.16/10/2016
Patient started experiencing Palpitation, Weakness
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7COURSE OF REACTION
17/10/2016Weakness & fatigue went on increasing and patient started getting muscle cramps and
constipation.
18/10/2016Muscle cramp and weakness become so severe that patient had to be admitted in our institute for
treatment..
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8COURSE OF REACTION
At our institute patient was examined and admitted to ward no. 5 under Dr. NDM
.
.After analysing patients blood reports
conclusion was drawn as Hypokalemia as a cause of patients symptoms.
.
.
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9COURSE OF REACTION
19/10/2016Patient recovered from symptoms and K values
started improving..
ADR reported to our department ..
20/10/2016Patient discharged
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10INVESTIGATIONS
DATE 18/10/2016 19/10/2016 20/10/2016
K+ (mEq/L) 2.80 2.74 4.02
Na (mEq/L) 142 140 139
Cl (mEq/L) 97 100 98
• PSMP negative.
• IgM dengue Negative.
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11SERIOUSNESS OF REACTION
• Reaction was serious as it required hospitalisation of patient.
OUTCOME -• Patient fully recovered on 20/10/2016.• Patient discharged on 20/10/2016.
DIAGNOSIS –CHLOROQUINE INDUCED HYPOKALEMIA.
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12
NARANJO SCALE
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13CAUSALITY ASSESSMENT
According to NARANJO SCALE score is 7
PROBABLE
BECAUSE1) Reasonable time-event relationship.2) De-challenge response positive.3) Could not be caused by other drugs and conditions.
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14HYPOKALEMIA
• K+ levels <3.5 mEq/L (<2.5 mEq/L)
• Normal range = 3.5 to 5.0 mEq/L
• Feeling Tired, Leg Cramps, Weakness, And
Constipation.
• It increases the risk of an abnormal heart
rhythm such as bradycardia and cardiac
arrest.
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15CAUSES OF HYPOKALEMIA
1. Decreased intake –
2. Redistribution into cells –
• Acid base
• Hormonal and drugs
• Anabolic state
3. Increased loss –
4. Genetic diseases -
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16DRUGS CAUSING HYPOKALEMIA
• Epinephrine• Pseudo ephedrine• Bronchodilators • Tocolytics• Theophylline• Caffeine• Verapamil (OD)• Chloroquine (OD)• Insulin (OD)
• Diuretics• Mineralocorticois• Gossypol • High dose
glucocorticoids• Penicillin, Ampicillin
(OD)• Cisplatin, Foscarnet,
Amphotericine B
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17CHLOROQUINE
• 1934 - Hans Andersag - Bayers Lab.
• Introduced - 1947 malaria prophylaxis.
• Given orally.
• Wide safety margin.
• Bioavailability = 89%
• PPB = 50%
• t1/2 = 3-10 days.
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18USES
• MALARIA – Prevention & Treatment.• Extra Intestinal Amoebiasis.• Rheumatoid arthritis.• DLE.• Lepra Reaction. • Porphyria Cutaneous Tarda.• Glioblastoma.• IN CT with pt of HIV/AIDS + Chikungunya Fever.• Radio sensitising Agent Chemotherapy.• In-Vitro Lysosomal Degradation of proteins.
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19SIDE EFFECTS
• Prolonged QT interval.• Diarrhoea.• Loss of appetite.• Nausea, Vomiting.• Muscle weakness, stomach cramps. • Retinopathy, accommodation problem, Headache.• Methemoglobinemia.• Haemolysis in G6PD deficiency.
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20INTERACTIONS
• Quinidine.
• Dapsone
• Mefloquine.
• Influenza vaccine
• Aluminium Hydroxide.
• Ampicillin.
• Aspirin.
• Ciprofloxacin
• Thioridazine
• Carvedilol
• Cimetidine
• Haloperidol
• Metoprolol
• Efavirenz
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21MECHANISM OF HYPOKALEMIA
• Retrospective Series of 191 consecutive acute chloroquine intoxications hypokalaemia was frequent (84%) (profound in less than 2 mmol/L in 11% of cases).• Mechanism = Depletion versus Intracellular transport.• It cannot be attributed to gastrointestinal losses, as no patient had diarrhoea; vomiting was inconstant (30%)
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22MECHANISM OF HYPOKALEMIA• No significant difference between the mean
plasma potassium concentration of patients who
vomited and those who did not.
• Urinary potassium = as the urinary potassium
losses were low and there was no statistical
relation between kaliuretic and plasma potassium
concentrations.
• Alkalosis = not cause (on average, an acid ph.)
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23MECHANISM OF HYPOKALEMIA
A shift of potassium from extracellular to
intracellular =
• Alkalosis.
• Insulin administration or glucose
administration.
• Intensive Beta Adrenergic stimulation.
• Hypokalaemia periodic paralysis.
• Hypothermia.
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24MANAGEMENT OF HYPOKALEMIA
• Reduction of K loss.• Replenishment of K loss.• Oral replacement with K+-Cl– is the mainstay of therapy.• K2Co3 or potassium citrate = patients with concomitant metabolic acidosis.• If hypokalaemia is severe (<2.5 mmol/L) = intravenous K+-Cl– can be administered through a central vein (rates of 10–20 mmol/h)
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25CONCLUSION
• A case of probable ADR presented due to overdose.• Wide safety margin drug.• Lots of side effects.• Proper dosage necessary.• Proper use necessary to avoid resistant.• Stop or reduce use once ADR detected.• Such ADR cases should be highlighted to provide better information and precaution to other health care providers.
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