Quinine-induced Arrhytmia in a Patient with Severe Malaria  

Oleh:

Gunawan, Carta A. ; Harijanto, Paul N. ; Nugroho, Agung

Jenis: Article from Journal - ilmiah nasional - terakreditasi DIKTI
Dalam koleksi: Acta Medica Indonesiana vol. 39 no. 01 (Jan. 2007), page 27.
Topik: severe malaria; parenteral quinine; arrhythmia

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Perpustakaan FK Nomor Panggil: A02.K.2004.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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ABSTRACT It was reported that there was a case of severe malaria patient with jaundice who presented with arrhythmia (premature ventricular contraction) while getting quinine iI/fusion was reported. A mall, 25 years old, was admitted to hospital with high fever, chill, vomiting, jaundice. The patient was fully conscious, blood pressure 120180 mmHg, pulse rate 100 xl minute, reguill/: On admission, laboratory examination showed Plasmodium falciparum (++++), total bilirubin 8.25 mg/dL, conjugated bilirubin 4.36 mgldL, ul/conjugated bilirubin 3.89 mg/dL, potassium 3.52 meqlL Patient was diagnosed as severe malaria with jaundice and got quinine infusion in dextrose 5 % 500 mgl8 hoUl: On the second day the patient had vomitus, diarrhea, tinnitus, loss of hearing. After 30 hours of quinine infusion the patient felt palpitation (l/Id electrocardiography (ECG) recording showed premature ventricular contraction (PVC) > 5 xl minute, trigemini, constant type - sinoatrial block, positive U wave. He was treated with lidocaine 50 mg intravenously followed by infusion 1500 mg in dextrose 5 %124 hour and potassium aspartate tablet. Quinine infusion was discontinued and changed with sulfate quinine tablets. Three hours later the patient felt bette/; the frequency of PVC reduced to 4 - 5 xl mil/ute and on the third day ECG was normal, potassium le\'el was 3.34 meqlL. He was discharged on 7'11 day in good cOl/dition. Quinine, like quinidine, is a chincona alkaloid that has al/ti-arrhythmic property, although it also pro-arrhythmic that can cause various arrhythmias, in eluding severe arrhyth¬mia such as multiple PVe. Administration of parenteral quinine must be done carefully and with good observation because of its pro-arrhythmic effect, especially in older patients who have heart diseases or patients with electrolyte disorder (hypokalemia) which frequently occurs due to \'ollliting and or diarrhea in malaria cases. INTRODUCTION Malaria remains the most important parasitic infection in the world, especially in tropical and subtropi¬cal countries (accounting for 40% of world population) and is the leading cause of morbidity and mortality. It is estimated that approximately one billion malaria cases occur every year, resulting in 3 million deaths. 1 In malaria, mortality is due to complications in many vital organs. Malaria with jaundice (total bilirubin level> 3 mg/ dL) is one of the complications found in patients with severe malaria (based on the WHO criteria). Study by Wenas et aF at Bethesda Hospital. Tomohon, North Sulawesi (1990-1993) demonstrated that 46% of hospitalized patients with severe malaria were jaundiced. Data from Manado General Hospital in 1995, 1997 and 1998 demonstrated that the most common presentation of patients with severe malaria was malaria with jaundice (36.8%, 42.1 %,41.4% respectively), followed by cerebral malaria and malaria with acute renal failure.3 Our study in Samarinda, East Kalimantan found that 62.9% of patients with severe malaria were jaundiced.4 In Thailand, Harinasuta et aP (1992) reported that 20 - 30% of hospitalized malaria patients were jaundiced. Generally, the management of jaundiced patients is the same as that of patients with severe malaria with other complications, which is by using parenteral quinine or artemisiI\iI\ derivatives (artemether or artesunate). 'The adverse effects of quinine are chinconislIl syndrome (tinnitus, temporary hearing loss, nausea, vomiting, dysphoria) that may occur at therapeutic levels (5-10 mg/L).6 Parenteral quinine may also cause hypoglyce¬mia due to stimulation of insulin secretion, hypotension and arrhythmia. 1.6 Rapid infusion of quinine can result

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