New Relevance of Hydroxychloroquine and Chloroquine in Forensic Toxicology

Hydroxychloroquine and chloroquine are long-standing antimalarial drugs recently brought into the spotlight as potential treatments for the pandemic-causing coronavirus (SARS-CoV-2). Notable publicity of their effectiveness in preliminary clinical trials seems to have contributed to increased calls to US poison control centers, and one recent report of accidental fatal ingestion of chloroquine phosphate algaecide. It is important for forensic toxicologists to be aware of the adverse effects and potential drug interactions associated with these drugs, which are widely available as treatments for Systemic Lupus Erythematosus (SLE) and aquarium cleaning products, respectively. Analytical testing for hydroxychloroquine and chloroquine may be accomplished using gas chromatography/mass spectrometry (GC/MS), liquid chromatography/tandem mass spectrometry (LC-MS/MS) and other methodologies (e.g., LC / time-of-flight) in blood and other body fluids. These compounds are not typically included in general unknown screens, so knowledge of the signs and symptoms may be important for informing testing strategies. Reference ranges for therapeutic and toxic effects can be used for comparison with concentrations of the parent compounds. Reports of overdose from the literature have described cardiac arrhythmias, hypotension, electrolyte imbalances, and coma.

Learning Objectives:

1. Attendees will learn to recognize the signs, symptoms and other indicators from case history that hydroxychloroquine or chloroquine may be relevant to a forensic toxicology investigation

2. Attendees will identify other drugs and medical conditions that may interact with hydroxychloroquine and chloroquine to produce toxic effects

3. Attendees will become familiar with recommended practices for collection, storage and analysis of forensic toxicology samples for hydroxychloroquine and chloroquine