1. A 35-year-old male presented with fever and body pain and was prescribed chloroquine by a private practitioner. After several days, the patient developed palpitations, weakness, muscle cramps and constipation. 2. Upon admission to the hospital, the patient was found to have hypokalemia which was determined to be caused by chloroquine overdose based on the Naranjo Scale assessment. 3. The patient recovered after being treated for hypokalemia and was discharged from the hospital.

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2. CASE
PRESENTATION
Dr. Pranesh Pawaskar
First year resident,
Dept. of pharmacology,
L.T.M.M.C. Sion, Mumbai 400022
Date :- 02/12/2016.
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3. CHLOROQUINE INDUCED
HYPOKALEMIA
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4. CASE
• 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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5. COURSE OF REACTION
11/10/2016
Patient started getting fever with chills
.
.
Fever went on becoming high grade
.
12/10/2016
Patient seek treatment from private practitioner
.
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6. COURSE 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
6

7. COURSE OF REACTION
17/10/2016
Weakness & fatigue went on increasing and patient
started getting muscle cramps and constipation
.
18/10/2016
Muscle cramp and weakness become so severe that
patient had to be admitted in our institute for
treatment
.
.
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8. COURSE 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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9. COURSE OF REACTION
19/10/2016
Patient recovered from symptoms and K values
started improving
.
.
ADR reported to our department
.
.
20/10/2016
Patient discharged
9

10. INVESTIGATIONS
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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11. SERIOUSNESS 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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13. CAUSALITY ASSESSMENT
According to NARANJO SCALE score is 7
PROBABLE
BECAUSE
1) Reasonable time-event relationship.
2) De-challenge response positive.
3) Could not be caused by other drugs and
conditions.
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14. HYPOKALEMIA
• 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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15. CAUSES 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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16. DRUGS 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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17. CHLOROQUINE
• 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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18. USES
• 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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19. SIDE 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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20. INTERACTIONS
• Quinidine.
• Dapsone
• Mefloquine.
• Influenza vaccine
• Aluminium Hydroxide.
• Ampicillin.
• Aspirin.
• Ciprofloxacin
• Thioridazine
• Carvedilol
• Cimetidine
• Haloperidol
• Metoprolol
• Efavirenz
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21. MECHANISM 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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22. MECHANISM 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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23. MECHANISM 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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24. MANAGEMENT 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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25. CONCLUSION
• 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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