Hemodialysis, peritoneal dialysis, plasmapheresis and forced diuresis for the treatment of quinine overdose.

Peritoneal dialysis, hemodialysis, plasma exchange and forced diuresis have been reported to accelerate removal of quinine following quinine poisoning. All these modalities were used simultaneously to treat a 19 year old youth who had become blind as a result of an overdose of quinine tablets. The serum quinine level was measured at 10.5 microgram/ml 13 hours after quinine ingestion. Forced diuresis accounted for the removal of 557 mg of quinine in the first 5 hours and a total of 1625 mg over 75 hours., A 6 hour hemodialysis recovered 30 mg of quinine while peritoneal dialysis removed an average of 1.6 mg/hr over the first 48 hours. Plasmapheresis over 3 hours exchanged 2 liters of plasma containing a total of 8.5 mg of quinine. Some vision returned 19 hours after quinine ingestion but did not become normal until 5 1/2 months later. We conclude that, hemodialysis, peritoneal dialysis and plasma exchange made only a minor contribution to quinine elimination by comparison with renal excretion of quinine.