title: Quinine-induced hepatotoxicity.
abstract: OBJECTIVE
  To report a case of quinine-induced hepatotoxicity presenting within 24 hours following the ingestion of the first dose.
  
  
  METHODS
  Case report information was obtained from the medical record, the patient, and the physicians involved in this patient's case. MEDLINE and Index Medicus were searched to obtain relevant published literature from January 1942 to May 1997 using the terms quinine, muscle cramps, liver disease, and hepatotoxicity.
  
  
  METHODS
  A 57-year-old Native American woman presented with symptoms of nausea, vomiting, generalized myalgia, headache, fever, chills, and rigor. The alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase concentrations were dramatically elevated. Quinine was suspected as the cause after several days of hospitalization and continued therapy. With discontinuation of the quinine, the patient's symptoms resolved within 48 hours and the liver enzyme concentrations declined within 72 hours.
  
  
  CONCLUSIONS
  Documented hepatotoxicity has occurred with quinidine, the optical isomer of quinine. Limited awareness of quinine-induced hepatotoxicity may result in an unrecognized adverse effect.
authors.affiliation: College of Pharmacy, South Dakota State University, Sacred Heart Hospital, Yankton 57078, USA. dfarver@sunflowr.usd.edu
authors.forename: D K
authors.initials: DK
authors.lastname: Farver
authors.forename: M N
authors.initials: MN
authors.lastname: Lavin
mesh_terms: D056486:Chemical and Drug Induced Liver Injury; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D016239:MEDLINE; D008875:Middle Aged; D009120:Muscle Cramp / Q000188:drug therapy / Q000503:physiopathology; D009125:Muscle Relaxants, Central / Q000009:adverse effects* / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000503:physiopathology; D011803:Quinine / Q000009:adverse effects* / Q000627:therapeutic use