This risk may increase with duration of use. NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. Most of the cases of liver injury are associated with the use of paracetamol (acetaminophen) at doses that exceed 4000 mg per day, and often involve more than one acetaminophen-containing product. Paracetamol has been associated with cases of acute liver failure, at times resulting in liver transplant and death. No value was found for serum alkalinization or extracorporeal methods of drug removal.For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only Warning

Treatment modalities need further study, but current recommendations are: (1) diazepam for seizures and sedation (2) early intubation and mechanical ventilation (3) epinephrine for treatment of vasodilation and myocardial depression (4) potassium replacement with close monitoring of levels (5) charcoal for gastrointestinal decontamination if ingestion occurred within an hour (6) high dose diazepam for life-threatening symptoms, until more information becomes available. Symptoms are similar to chloroquine and treatment must be implemented quickly and should be modeled after experience with chloroquine overdoses. Although hydroxychloroquine overdoses are very rare, life-threatening hypotension, conduction problems, and hypokalemia can occur within 30 minutes of ingestion. The patient's hypotension resolved within 4.5 hours, serum potassium stabilized in 24 hours, and tachycardia gradually decreased over 3 days. Toxicologic tests confirmed the presence of hydroxychloroquine. She was treated with fluid boluses and dopamine, oxygen, and potassium supplementation. A 16-year-old girl ingested a handful of hydroxychloroquine 200mg, 30 minutes before presentation and presented with tachycardia (heart rate 110 beats/min), hypotension (systolic blood pressure 63 mm Hg), central nervous system depression, conduction defects (QRS = 0.14 msec), and hypokalemia (K = 2.1 meq/L).

We report a case and review the literature. Hydroxychloroquine overdoses are rarely reported with 7 previous cases found in the English medical literature.

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