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Primaquine overdose in a toddler. Am J Emerg Med 2021 Jul;45:676.e3-676.e5

Date

12/07/2020

Pubmed ID

33279327

DOI

10.1016/j.ajem.2020.10.084

Scopus ID

2-s2.0-85097381102 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

Antimalarial medications carry a risk of rare, but serious side effects. Primaquine in particular is known to cause methemoglobinemia and hemolytic anemia. In patients with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency, these side effects become amplified and can be life-threatening. This can complicate treatment plans as the recommended first-line management of severe methemoglobinemia, methylene blue, may cause or worsen hemolytic anemia in G6PD deficient patients. We present a case of a toddler with an accidental primaquine overdose who had undiagnosed G6PD deficiency. Over the 2 days following his ingestion he developed severe methemoglobinemia and hemolytic anemia toxicity. He was initially treated with a dose of methylene blue prior to learning of his G6PD deficiency. He was subsequently given additional doses of ascorbic acid and a blood transfusion. His condition gradually improved and he was ultimately discharged in good condition. To our knowledge, this case represents a unique presentation of mixed methemoglobinemia and hemolytic toxicity due to an accidental primaquine overdose in a G6PD deficient pediatric patient. Though cases remain relatively rare, pediatric patients represent the vast majority of known primaquine overdoses. Their diagnosis and treatment require maintaining a high index of suspicion and a good working knowledge of antimalarial toxicities and management options.

Author List

Visclosky T, Schaeffer W, Pomeranz E, Ponce DM

Author

William J. Schaeffer DO Assistant Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anemia, Hemolytic
Antimalarials
Child, Preschool
Drug Overdose
Glucosephosphate Dehydrogenase Deficiency
Humans
Male
Methemoglobinemia
Primaquine