Disseminated Intravascular Coagulation Due to Drinking Tonic Water.

Sasmith R Menakuru,Ahmed Salih,Adelina Priscu,Vijaypal Dhillon

doi:10.7759/cureus.20512

Abstract

Quinine has been used worldwide to treat malaria; however, it is now used as an agent for night-time muscle cramping. The compound, derived from Cinchona tree bark, is found in antimalaria medication, supplements for leg cramping, and beverages such as tonic water and bitter lemon. Quinine, however, is not without its side effect profile which includes a wide range of ailments ranging from nausea to disseminated intravascular coagulation. The authors present a case of a 35-year-old man diagnosed with disseminated intravascular coagulation due to an excessive intake of tonic water because his friend told him that it would help alleviate nighttime leg cramping. We strive to inform physicians about the side effect profile of quinine and stress that a pertinent history must be elicited in patients with unknown causes of disseminated intravascular coagulation.

Highlights

Quinine is a well-known naturally occurring substance from the bark of Cinchona trees found in parts of western Africa, South America, and the Caribbean islands
Quinine was used as a medication to fight malaria and has been successful; there has been a decline in usage as better compounds with fewer side effects have been developed [1]
We present a case of a 35-year-old male who presented with disseminated intravascular coagulation with no past medical history, took no medications, and on further examination, was found to be drinking tonic water exclusively for night-time leg cramping for 10 days

Summary

Introduction

Quinine is a well-known naturally occurring substance from the bark of Cinchona trees found in parts of western Africa, South America, and the Caribbean islands. We present a case of a 35-year-old male who presented with disseminated intravascular coagulation with no past medical history, took no medications, and on further examination, was found to be drinking tonic water exclusively for night-time leg cramping for 10 days. Sepsis was initially the diagnosis made, and the patient was started on empiric vancomycin and piperacillin-tazobactam for broad-spectrum coverage but was later ruled out as none of the investigations pointed to a septic picture His ANA was negative, and lupus anticoagulant was not detected, and he did not have any hematologic cancer as confirmed by the blood smear. Broad-spectrum antibiotics were stopped after negative blood and urine cultures came back His coagulation profile, hemoglobin, and platelets normalized after six days. He followed up with the hematologic clinic five days after discharge and again in four weeks, and both times his labs were within his normal limits (Table 1)

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