Pharmacokinetics and clinical toxicity of quinine overdosage: lack of efficacy of techniques intended to enhance elimination.

We report clinical details in 16 cases of quinine poisoning. Plasma quinine concentrations above 15 mg/l were associated with increased risks of permanent visual damage and of cardiac arrhythmias from which one of our patients died. The rate of quinine elimination was not significantly altered by forced acid diuresis in five patients (t 1/2 25.1 +/- SEM 4.6 h) as compared to eight patients treated conservatively (t 1/2 26.5 +/- SEM 5.78 h). Neither urinary pH or flow rate correlated consistently with urinary quinine clearance. In three other patients charcoal column haemoperfusion, haemodialysis and exchange transfusion were performed. These were also ineffective in increasing quinine elimination. It is concluded that techniques advocated to increase quinine elimination are ineffective in the management of quinine poisoning.