Barking Up the Wrong Tree (Cinohonism, Quinine & Quinidine) скачать в хорошем качестве

Barking Up the Wrong Tree (Cinohonism, Quinine & Quinidine)

In this episode Ryan and Toxo discuss some potential toxic spices and break down the toxicity and treatment of a once well known medicine Cinchona Bark, Quinine, and Associated Toxicities Historical Perspective • Use of Cinchona Bark Powder for Malaria: • https://www.ncbi.nlm.nih.gov/pmc/arti... • Evolutionary Pressure of Malaria on Sickle Cell Traits: • https://www.ncbi.nlm.nih.gov/pmc/arti... Cinchonism • Definition: Classic toxicities caused by ingestion of quinoline derivatives from cinchona bark. • Brief Review: • https://pubmed.ncbi.nlm.nih.gov/32644... Etiology • Sources: • Powdered cinchona bark: Used in tonic water, to treat restless legs, or as a remedy for certain viruses. • Prescription quinoline derivatives: • Quinine • Quinidine • Hydroxychloroquine • Chloroquine Clinical Effects • Symptoms: • Dizziness, flushing, headache, tinnitus. • Potential for vision loss. • Laboratory Abnormalities: • Hypoglycemia, hypokalemia, long QRS. Treatment Supportive Care: • Manage airway, breathing, and circulation (ABCs). • Early use of epinephrine as a preferred pressor based on animal and chloroquine data. Correct Endocrine/Metabolic Abnormalities: • Hypertonic Sodium: For wide QRS (use cautiously to avoid worsening hypokalemia). Decontamination: • Consider multi-dose activated charcoal for significant ingestions. Ocular Toxicity • Key Findings: • Ocular toxicity is often delayed but can become permanent. • Quinine levels ＞15 are associated with increased ocular toxicity. • Quinine-induced blindness: https://pubmed.ncbi.nlm.nih.gov/3983356/ • Hall AP, et al. Quinine-induced blindness. Br J Ophthalmol. 1997. doi:10.1136/bjo.81.12.1029 • Recovery: • Vision may recover centrally first, then peripherally. • Hyperbaric oxygen therapy (HBO) is often used but remains debated. Ototoxicity • Mechanism: • Tinnitus caused by microstructural changes in the outer hair cells of the cochlea and organ of Corti. • Vasoconstriction and prostaglandin inhibition contribute to decreased hearing. • Studies: • Jastreboff PJ, et al. Quinine-induced tinnitus in rats. Arch Otolaryngol Head Neck Surg. 1991. doi:10.1001/archotol.1991.01870220110020 • Roche RJ, et al. Quinine induces reversible high-tone hearing loss. Br J Clin Pharmacol. 1990. doi:10.1111/j.1365-2125.1990.tb03704.x More on Toxicity from Studies 1. Cardiac Arrhythmias in Patients Taking Quinine Alone:Padmaja UK, Adhikari P, Periera P. Experience with quinine in falciparum malaria. Indian J Med Sci. 1999. PMID: 10695226. 2. Negative Inotropic Effects of Quinidine:Hoffmeister HM, et al. Negative inotropic effect of class-I antiarrhythmic drugs. Eur Heart J. 1987. doi:10.1093/oxfordjournals.eurheartj.a062178. 3. Tinnitus and Hearing Effects: Jarboe JK, Hallworth R. The effect of quinine on outer hair cell shape, compliance and force. Hear Res. 1999. doi:10.1016/s0378-5955(99)00031-3. Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) (https://thepoisonlab.aweb.page/p/cf63...) Join as a supporting member (https://thepoisonlab.com/support) • Ad free episodes • Bonus content and early access • Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game! (WWW.GOTTAPICCEM.COM) Tox trinkets (Rep the show at home!) (https://www.etsy.com/shop/ThePoisonLab) Reach the show • Email: [email protected] More Show Resources • Ryan's Medical Games and Resources (https://the-poison-lab.yolasite.com/) • Show Website (https://www.thepoisonlab.com)