Cinchonism or quinism is a pathological condition in humans caused by an overdose of quinine or its natural source, cinchona bark. Quinine is used to treat resistant malaria, nocturnal muscle cramps and can also act as an abortifacient. 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, or from small doses over a longer period of time, not from the amounts used in tonic drinks, but possibly from ingestion of tonic water as a beverage over a lengthy period of time. Quinidine (Class 1A anti-arrhythmic) can also cause cinchonism. A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... Quinine (IPA: ) is a natural white crystalline alkaloid having antipyretic (fever-reducing), anti-smallpox, analgesic (painkilling), and anti-inflammatory properties and a bitter taste. ... Species See text Cinchona L., is the name of a genus in Rubiaceae family, large evergreens that can grow over 10 metres tall. ... Malaria is a vector-borne infectious disease caused by protozoan parasites. ... An abortifacient is a substance that induces abortion. ... The Canada Dry brand of tonic water, shown on the right under ultraviolet light, quinine, even in negliglible quantity makes the liquid fluorescent Tonic water (or Indian tonic water) is a carbonated soft drink flavored with quinine. ... Quinidine is a pharmaceutical agent that acts as a class I antiarrhythmic agent in the heart. ... Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. ...

Signs and symptoms

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, lichenoid photosensitivity [1], vertigo, dizziness, dysphoria, nausea and vomiting, and diarrhea. A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... Tinnitus (pronounced or ,[1] from the Latin word for ringing[2]) is the perception of sound in the human ear in the absence of corresponding external sound(s). ... Lichen planus is an inflammatory disease that affects the skin and the oral mucosa. ... Photosensitivity is the amount to which an object reacts upon receiving photons of light. ... Balance is the result of a number of body systems working together. ... Many different terms are often used to describe what is collectively known as dizziness. ... Look up dysphoria in Wiktionary, the free dictionary. ... For other uses, see Nausea (disambiguation). ... Heaving redirects here. ... In medicine, diarrhea, also spelled diarrhoea (see spelling differences), refers to frequent loose or liquid bowel movements. ...

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 overdose can also result in a rare form of hypersensitivity reaction termed blackwater fever that results in massive hemolysis, hemoglobinemia, hemoglobinuria, and renal failure. (reference needed) Anaphylaxis is a severe and rapid systemic allergic reaction to a trigger substance, called an allergen. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Blackwater fever is a complication of malaria characterized by intravascular haemolysis, haemoglobinuria and kidney failure. ... {{otheruses4|1=medical hemoglobin]] into the surrounding fluid (plasma, in vivo). ... In medicine, haemoglobinuria is a condition in which the oxygen transport protein haemoglobin is found in abnormally high concentrations in the urine. ... Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. ...

Patients treated with quinine may also suffer from hypoglycemia (especially if administered intravenously) and hypotension (low blood pressure). In very high doses (higher than those used to treat malaria) during the first trimester of pregnancy quinine may act as an abortifacient, or cause birth defects, especially deafness. Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... A sphygmomanometer, a device used for measuring arterial pressure. ... For the term trimester used in academic settings, see Academic term The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ... An abortifacient is a substance that induces abortion. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ...

Most symptoms of cinchonism (except in severe cases) are reversible and disappear once quinine is withdrawn.

External links

• IPCS INTOX databank entry for quinine
• Side effect of quinine for nocturnal cramps - letter printed in the British Medical Journal with a photograph of hands affected by lichenoid photosensitivity
• Effects of Quinine on the Excitability and Voltage-Dependent Currents of Isolated Spiral Ganglion Neurons in Culture