title: Quinine and the ABCs of Long QT: A Patient's Misfortune with Arthritis, (Alcoholic) Beverages, and Cramps.
abstract: A 91-year-old woman presented to the emergency department by ambulance after her family found her minimally responsive. Telemetry monitoring demonstrated episodes of non-sustained polymorphic ventricular tachycardia (PMVT) associated with significantly prolonged repolarization. Her medical history revealed that she was taking quinine or a derivative in three different forms: hydroxychloroquine, quinine sulfate (for leg cramps), and her gin mixed with tonic water (containing quinine). The present case is illustrative of classic etiologies and findings of acquired long QT syndrome, and serves as an important reminder for providers to take a complete medication history, including use of duplicative and alternative medicines and type of alcohol consumption.
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA. etryon@salud.unm.edu.
authors.forename: Elyce T
authors.initials: ET
authors.lastname: Sheehan
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Frizzell
authors.affiliation: San Juan Regional Medical Center, Farmington, NM, USA.
authors.forename: Jude
authors.initials: J
authors.lastname: Gabaldon
authors.affiliation: San Juan Regional Medical Center, Farmington, NM, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: West
mesh_terms: D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002253:Carbonated Beverages / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D018565:Food-Drug Interactions; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects; D008133:Long QT Syndrome / Q000139:chemically induced*; D009120:Muscle Cramp / Q000188:drug therapy; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D011803:Quinine / Q000009:adverse effects*
chemical_list: D018501:Antirheumatic Agents; D009125:Muscle Relaxants, Central; D006886:Hydroxychloroquine; D011803:Quinine
keywords: cardiac arrhythmia; gin and tonic; prolonged QT; quinine