Quinine
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Disseminated intravascular coagulopathy in an elderly patient: case report A 67-year-old woman developed disseminated intravascular coagulopathy during treatment with quinine for leg cramps. The woman, who had a history of asthma, type 2 diabetes mellitus, controlled hypertension, gastrooesophageal reflux and liver echinococcosis, began receiving quinine 300mg [frequency and route not stated]. Concomitant medications were pantoprazole, nifedipine, salbutamol [albuterol] and paracetamol. One day after starting quinine, she presented with episodic, sharp, rightsided chest pain radiating from her right shoulder. General physical and systemic examination was normal apart from petichiae at the shoulder blades. There was history of a recent nose bleed. Investigations revealed the following: haemoglobin, 13.6 g/dL; WBC count, 3.1; neutrophil count, 0.9; platelets, 98; band forms, 1.4; and lymphocytes, 0.4. A blood film revealed increased band forms, poikilocytosis, and decreased platelets; C-reactive protein, < 6, erythrocyte sedimentation rate, 45; activated partial thromboplastin time (APTT), 63 sec; INR, 4.2; D dimers, >3.2 mg/L; fibrin/fibrinogen degradation products (FDP) were also increased. Her lactate dehydrogenase (LDH) was 2135 mg/L and her troponins were < 0.15 mg/L. There was no clinical evidence of malaria and she was not investigated for malarial parasites. The woman was admitted to the ICU and she was treated conservatively. Her APTT and INR normalised on the second day and her platelet count recovered after 4 days. Her neutrophil count recovered after 3 days. Her LDH demonstrated a downward trend. Platelet associated antibodies and quinine dependent platelet antibodies were not detected. She was asymptomatic and stable and, after 7 days of hospitalisation, she was discharged. Author comment: "[Disseminated intravascular coagulopathy] has been previously reported with quinine which is characterised by laboratory evidence of consumption and proteolytic degradation of haemostatic components." Nadeem MK, et al. Quinine induced disseminated intravascular coagulopathy. Australasian Medical Journal 4: 488-489, No. 9, Jan 2011. Available from: URL: 803065557 http://dx.doi.org/10.4066/amj.2011.873 - Australia
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Reactions 14 Jan 2012 No. 1384
