Cinchonism

Cinchonism
Classification and external resources
Specialty	emergency medicine
ICD-10	T37.2
ICD-9-CM	386.9, 961.4
DiseasesDB	11124
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Cinchonism or quinism is a pathological condition caused by an overdose of quinine or quinidine, or their natural source, cinchona bark. Quinine is medically used to treat malaria. In much smaller amounts, quinine is an ingredient of tonic drinks, acting as a bittering agent. Cinchonism can occur from therapeutic doses of quinine, either from one or several large doses. Quinidine (Class 1A anti-arrhythmic) can also cause cinchonism symptoms to develop with as little as a single dose.

Symptoms of mild cinchonism (which may occur from standard therapeutic doses of quinine) include flushed and sweaty skin, ringing of the ears (tinnitus), blurred vision, impaired hearing, confusion, reversible high-frequency hearing loss, headache, abdominal pain, rashes, drug-induced lichenoid reaction (lichenoid photosensitivity),vertigo, dizziness, dysphoria, nausea, vomiting and diarrhea.

Large doses of quinine may lead to severe symptoms of cinchonism: skin rashes, deafness (reversible), somnolence, diminished visual acuity or blindness, anaphylactic shock, and disturbances in cardiac rhythm or conduction, death from cardiotoxicity. Quinine may also trigger a rare form of hypersensitivity reaction in malaria patients termed blackwater fever that results in massive hemolysis, hemoglobinemia, hemoglobinuria, and renal failure.

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