FW: E-DRUG: Quinine

e-drug
1

Hi

I have asked the man:

I wonder, isn't imi Quinine a bit hazardous?

better than sub-dermal plasmodium injection. seriously, i do not know of
any plasma levels tested with im quinine. my main concern is that a
sub-theraputic dose may be given.

I have currently three malaria patients in my ward, two of them with
Chloroquine resistance the other one is vomiting, so they are all
getting ivi Quinine.

The counts range from 1.4% (vomiting), 1.6% (RII) to 20% (RIII).

The two resistant patients were fitting yesterday, which makes it
cerebral malaria in my book, but responded well to additional ivi
Glucose 50%, Diazepam and Phenytoin.

All three responded very well, the counts are 0% (48hrs), 0.1% (24hrs),
and 1% (24 hrs). The RIII case has haemolytic anemia, HB of 6 and is
jaundiced, the LFTs are not back, Urea and electrolytes are normal.

I have discussed this extensively with the nursing staff who insist
to put ivi quinine (10mg/kg in 200ml D5W over 4 hours every 8 hours).
They say the workload is insignificant (and they were really astonished
abut this being any issue).

They also note something that I overlooked, namely patients with severe
or complicated malaria need iv fluids which is the cost factor that you
can't save by giving quinine imi. The 200ml bags are more convenient,
but if the cost is the issue you just put the quinine in the 8hly
vaculitre.

I'd really like to hear from Mombaza and the other places advocating this
if they ever did plasma levels.

Overdosage in children is also a major concern to me, once it's in, it's
in, whereas you can stop the drip if necessary.

All in all, I am not going to consider imi quinine under any circumstances.

el

--
Dr. Eberhard W. Lisse\ / Swakopmund State Hospital
<el@lisse.NA> * | Resident Medical Officer
Private Bag 5004 \ / +264 81 124 6733 (cell) 64 461005(h)
461004(f)
Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108)
Vice-Chairman, Board of Trustees, Namibian Internet Development Foundation,
an Association not for Gain. NAMIDEF is the Namibian Internet Service
Provider.

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2

Dr Eberhard W Lisse wrote:

Hi

I have asked the man:

>>I wonder, isn't imi Quinine a bit hazardous?
>>
>better than sub-dermal plasmodium injection. seriously, i do not know of
>any plasma levels tested with im quinine. my main concern is that a
>sub-theraputic dose may be given.

I have currently three malaria patients in my ward, two of them with
Chloroquine resistance the other one is vomiting, so they are all
getting ivi Quinine.

The counts range from 1.4% (vomiting), 1.6% (RII) to 20% (RIII).

The two resistant patients were fitting yesterday, which makes it
cerebral malaria in my book, but responded well to additional ivi
Glucose 50%, Diazepam and Phenytoin.

All three responded very well, the counts are 0% (48hrs), 0.1% (24hrs),
and 1% (24 hrs). The RIII case has haemolytic anemia, HB of 6 and is
jaundiced, the LFTs are not back, Urea and electrolytes are normal.

I have discussed this extensively with the nursing staff who insist
to put ivi quinine (10mg/kg in 200ml D5W over 4 hours every 8 hours).
They say the workload is insignificant (and they were really astonished
abut this being any issue).

They also note something that I overlooked, namely patients with severe
or complicated malaria need iv fluids which is the cost factor that you
can't save by giving quinine imi. The 200ml bags are more convenient,
but if the cost is the issue you just put the quinine in the 8hly
vaculitre.

I'd really like to hear from Mombaza and the other places advocating this
if they ever did plasma levels.

Overdosage in children is also a major concern to me, once it's in, it's
in, whereas you can stop the drip if necessary.

All in all, I am not going to consider imi quinine under any circumstances.

el

--
Dr. Eberhard W. Lisse\ / Swakopmund State Hospital
<el@lisse.NA> * | Resident Medical Officer
Private Bag 5004 \ / +264 81 124 6733 (cell) 64 461005(h)
461004(f)
Swakopmund, Namibia ;____/ Domain Coordinator for NA-DOM (el108)
Vice-Chairman, Board of Trustees, Namibian Internet Development Foundation,
an Association not for Gain. NAMIDEF is the Namibian Internet Service
Provider.

--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.

Chloroquin resistance is so high at the Kenyan Coast that we are in the
processs of removing it as a first line drug. In fact one of the major
problems we have is chloroquin overdose. A child presents with fever and
the mother gives him chloroquin, the child does not improve and is taken
to a private clinic where he is also given chloroquin again and then
taken to a dispensary or a health centre or outpatient department of a
district or a subdistrict hospital where he is given chloroquin again.
Patients with complications of malaria such as hypoglycaemia,dehydration
convultions are treated with appropriate medications eg IV dextrose for
hypogycaemia,dehydration with IV fluids ,fits with diazepam.Quinine is
given IM ( or IV if he is going to receve IV fluids to correct
dehydration). At any one time the hospital has 10-15 children in the
paediatric ward with malaria and all of them on quinine.
We had a difficult time convincing the staff about using IM quinine.
We are now in the process of providing quinine to the rural health
facilities.
There have been studies on plasma levels after IM and IV quinine from
Gambia and Kenya.Will send you the references after the holidays.
It is very encouraging to have the debate on quinine.
Maybe some expert on malaria will comment.
I am just physcian who deals with everything under the sun including
which includes all diseases including "syndrome of inadequate rsourses
for health" (SIRH).
DR S K SHARIF
P O BOX 80398
MOMBASA
KENYA

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