SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P52
PEDIATRIC FATALITY DUE TO HYDROXYCHLOROQUINE INGESTION
H. Nipper*, P. Studts, R. Baltaro, Creighton University Medical Center, Omaha, NE, 68131
A 7 year-old African-American female was found at home unresponsive and cold approximately 4 hr after
being given acetaminophen and sent to bed to rest after complaining of stomach ache and headache.
At autopsy, findings were unremarkable for clues as to cause of death. Heart blood and vitreous humor
were sent to Creighton University Medical Center for forensic testing. Initially, serum and vitreous humor
electrolytes, hemoglobin electrophoresis were ordered, but all results were within expected limits. The
acetaminophen level was 57.6 ~g/mL.
Further testing was performed using gas chromatography with FIDINPD on an alkaline extract of blood.
The presence of an unfamiliar peak was noted and the Douglas County (Nebraska) Coroner was alerted to
return to the home with investigators to perform a full inventory of pharmaceuticals. The inventory
included numerous arthritis medications including one identified as "hydroxychlor." The parents
determined with investigators present that eleven 200 mg tablets (2.2g total drug) were unaccounted for
from the bottle that they thought was stored safely.
Simultaneously the laboratory was identifYing the unknown GC peak as hydroxychoroquine using GCIMS
with a dosage form from the hospital pharmacy as a standard.
Quantitation of the blood level of hydroxy chloroquine performed at National Medical Services revealed 70
IJ.g1mL. (NMS therapeutic range: 0.1-1.0 IJ.g1mL) The cause of death was subsequently ruled to be acute
overdose of hydroxy chloroquine. The manner of death was ruled to be accidental.
According to the PDR (1) "Children are especially sensitive to the 4-aminoquinoline compounds. A
number of fatalities have been reported following the accidental ingestion of chloroquine, sometimes from
relatively small doses (0.75-1.0 g in one three-year-old child). Parents should be strongly warned to keep
these drugs out of reach of children." Early symptoms of overdose are headache and drowsiness, and may
occur within 30 minutes of ingestion. These symptoms may be followed by cardiovascular collapse, and
"sudden and early respiratory and cardiac arrest". (1)
1. Physicians Desk Reference (PDR), 58 th ed., (2004) p. 3031, Thomson PDR, Montvale, NJ 07645.
Keywords: Pediatric, Postmortem toxicology, Hydroxychloroquine, Fatality
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