Sunil Kumar Sharma, Pradeep Kumar Mohanty, Bhabagrahi Rath, Suresh Chandra Sahoo
BACKGROUND
Cinchona alkaloids Quinidine, Quinine commonly used as anti-malarial are able to suppress ionic conductance through K+ Na+ Ca++ channels in the membranes of a variety of different cells, blocking of outward membrane repolarising K+ current by quinidine can produce EADs and triggered rhythm in presence of low extracellular potassium. Hypokalaemia can occur early in treatment of malaria and is associated with prolonged repolarization. Hence presence of these two substrates can precipitate ventricular tachyarrhythmia in malaria.
The objectives of the study were to evaluate the occurrence of ventricular tachyarrhythmia and whether administration of quinine in dextrose solution is the precipitating factor for development of tachyarrhythmia by precipitating hypokalaemia.
MATERIALS AND METHODS
Present study was conducted in VSS Medical College now VSSIMASR Burla, Sambalpur, Odisha from June 1997 to Dec 2017. Severe falciparum malaria patients in the age group of 5 yrs. to more 70 years patient receiving quinine in dextrose solution and Artesunate IV or IM were observed for development of any sudden cardiac death, survivor cardiac arrest or VT. Serum potassium concentration and Q-Tc interval was measured in all cases.
RESULTS
234 cases of sudden cardiac death, survivor of cardiac arrest and VT were observed in patients receiving IV quinine but no event with Inj. Artesunate. Hypokalaemia and long Q-Tc was observed in all the cases developing ventricular tachyarrhythmia. Arrhythmia improved with rapid correction of potassium.
CONCLUSION
Current practice of administration of quinine in dextrose solution predisposes severe malaria to develop hypokalaemia. Hypokalaemia by prolonging repolarization predispose makes malaria patients susceptible to develop ventricular tachyarrhythmia in presence quinine. Hence quinine should not be used with dextrose solution and if it is essential to use, then early recognition and correction of hypokalaemia is essential to prevent ventricular tachyarrhythmia.
