Acute chloroquine poisoning

HISTORY: After a quarrel with her husband a 50-year-old woman swallowed, together with some alcohol, 15 tablets of a chloroquine preparation (3.75 g chloroquine phosphate) with suicidal intent. She had no known psychiatric history. CLINICAL FINDINGS: An emergency physician called by the husband two hours after the tablet ingestion found her to be deeply comatose. After preventive nasotracheal intubation she had a grand mal seizure. On advice from a Poison Emergency Centre which was contacted while in the patient's apartment diazepam, 60 mg as a bolus, was injected intravenously, and controlled respiration was started. COURSE: After admission in hospital, gastrolavage was performed and diazepam therapy was continued with 40 mg per hour, gradually reduced until discontinued after 45 hours. The patient was transferred to an ordinary ward from the intensive care unit on the fifth day, without cardiac or neurological sequelae. CONCLUSION: The most important measures after a diagnosis of chloroquine poisoning are immediate intubation so that diazepam (1 mg/kg) can be administered intravenously as specific antidote without danger of severe respiratory failure.