Therapeutic trial of diazepam versus placebo in acute chloroquine intoxications of moderate gravity.
OBJECTIVE
Acute chloroquine intoxication is responsible for a membrane-stabilising effect which results in electrocardiographic (ECG) and hemodynamic disturbances. Diazepam is used in acute chloroquine intoxication on the basis of clinical and experimental observations, but its utility alone, in man, remains unproven. The goal of this study was to verify whether diazepam alone has an effect on the membrane-stabilising effect observed in moderately severe chloroquine intoxications.


METHODS
Prospective, multi-center, double-blind, placebo-controlled study.


METHODS
Prehospital mobile intensive care units (Paris) and hospital intensive care units (paris and Dakar).


METHODS
Adults with moderately severe intoxication defined as: a suspected ingested dose of 2 or more but less than 4 g, systolic blood pressure (SBP) higher than 80 mmHg, QRS duration less than 0.12 s and the absence of dysrhythmia at inclusion.


METHODS
Patients received either a loading dose of 0.5 mg/kg diazepam followed by an infusion of 1 mg/kg over 24 h or an equivalent volume of placebo.


RESULTS
Outcome was measured by serial assessments of SBP, ECG (QRS and QT segments) and clinical deterioration. There were no significant differences observed in the initial or serial ECG or SBP measurements. There were no deaths and no patient had to be removed from the study due to clinical deterioration.


CONCLUSIONS
Diazepam, at the dose studied, does not appear to reverse the chloroquine-induced membrane-stabilising effect in acute moderately severe chloroquine intoxication. Supportive intensive care of these intoxications appears to be all that is necessary.
Clemessy
J L
JL
Service de Réanimation Toxicologique, Hôpital Fernand Widal et Université de Paris VII, France.
Angel
G
G
Borron
S W
SW
Ndiaye
M
M
Le Brun
F
F
Julien
H
H
Galliot
M
M
Vicaut
E
E
Baud
F J
FJ
D000208:Acute Disease; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D000962:Antimalarials / Q000506:poisoning*; D002738:Chloroquine / Q000506:poisoning*; D003975:Diazepam / Q000627:therapeutic use*; D004311:Double-Blind Method; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D011041:Poisoning / Q000188:drug therapy; D011446:Prospective Studies; D012720:Severity of Illness Index; D013405:Suicide
D000927:Anticonvulsants; D000962:Antimalarials; D002738:Chloroquine; D003975:Diazepam