A late presentation of ocular quinine toxicity managed with a combination of vasodilatory treatments.

摘要

A 39-year-old female patient presented to our A + E Department 12 h after taking an overdose of quinine sulphate (300 mg tablets x 28).She complained of blurred vision and nausea. Blood pressure was 105/55 mmHg, pulse 144 min~(-1), ECG showed sinus-tachycardia. Intravenous fluids, antiemetics, and 50 g of activated charcoal were administered.After 6 h, the right visual acuity (RVA) deteriorated to hand movements. The left eye was amblyopic, pre-existing acuity being perception of light (PL). She was referred to ophthalmology the next day.At the first ophthalmology review (40 h after overdose), visual acuity was PL bilaterally with inaccurate projection. Pupils were dilated with sluggish direct and consensual responses. Fundoscopy showed attenuated arteries, retinal pallor and normal discs. Fluorescein angiogram (FFA) demonstrated normal arm-to-circulation time with bilateral rapid disc filling in the choroidal phase. Arterio-venous transit time was within normal limits with no evidence of damage to theouter blood retinal barrier. Oral nimodipine (60 mg x 6 day~(-1)) was started.Vision remained unchanged by the fourth admission day, so intravenous clonidine infusion (300 mug/24 h) was administered for 24 h in HDU. Right stellate ganglion block (SGB) (ropivicaine1% 10 ml) was performed 1 hr after the start of the infusion without complication.On the seventh admission day RVA started to improve. By day 9, RVA was 6/12 unaided, 6/9 with pinhole. The left amblyopic eye remaining PL. Fundoscopy showed arteriolar attenuation with pale discs. Right colour vision was impaired (17/21 Ishihara plates correct) with grossly constricted visual field.