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Self-Medication in a Time of Plague
Chloroquine has been mentioned widely as a treatment for COVID-19 and President Trump recently mentioned it favorably. There is some in vitro science and mechanistic support for this use (it exhibits antiviral properties against both SARS and COVID-19 coronaviruses), demonstrated clinical utility in SARS, and shows promise in use against COVID-19.
Like many human drugs, it also has veterinary use, and one example of this has hit the headlines. Not only have the usual MSM sources done their usual sterling job of reportorial misfeasance and malfeasance, (combined with Blame Trump, of course) the conservative snarkitariate has been spreading the fake news, demonstrating the wisdom of the old advice to engage brain before putting mouth in gear.
NBC:
An Arizona man has died after ingesting chloroquine phosphate — believing it would protect him from becoming infected with the coronavirus. The man’s wife also ingested the substance and is under critical care.
The toxic ingredient they consumed was not the medication form of chloroquine, used to treat malaria in humans. Instead, it was an ingredient listed on a parasite treatment for fish.
[…]
The couple unfortunately equated the chloroquine phosphate in their fish treatment with the medication —known as hydroxychloroquine — that has recently been touted as a possible treatment for COVID-19, which has infected more than 42,000 people in the U.S. and killed at least 462.
Ace of Spades does a great job of addressing the media malfeasance/blame Trump aspect but displays just as much ignorance as did NBC. And, sadly as the Arizona couple.
Ben Shapiro likewise, and reportedly President Trump retweeted this:
Blaming Trump for someone ingesting fish tank cleaner is a new level of Trump Derangement Syndrome.
— Ben Shapiro (@benshapiro) March 24, 2020
And Mary Chastain at Legal Insurrection also spread the stupidity:
During a press conference, Trump spoke about studies that showed chloroquine (generic name hydroxychloroquine) treated coronavirus.
So this elderly couple in Arizona thought the additive chloroquine phosphate in fish tank cleaner was the same thing.
They proceeded to drink the fish tank cleaner.
The man died. The woman is in ICU.
One of the last things my stepfather A”H said was “just don’t add to the confusion.” Ben, Mary, Ace… you’re confusing things. You ought to know better.
First the disclaimer: I’m not an MD, DO, NP or PA. Or DVM. I can’t write prescriptions for drugs. That said, I majored in biochemistry and minored in chemistry, have practical experience as a lab tech (meaning weighing out precise amounts of powders, measuring precise amounts of liquids, and mixing them up.) Also meaning having survived a few hazardous situations along the way (sulfuric acid geyser, anyone?) some of which definitely did not make me stronger though they obviously didn’t kill me. and have been reading medical and then biomedical primary and secondary literature for more than 50 years now.
Now the attempt at correction:
There are two forms of chloroquine used in medicine; Hydroxychloroquine which is available as a generic or as the brand name drug Plaquenil. There is also chloroquine itself, which is most commonly dispensed as, yes, Ben, yes, Mary, yes Ace’s moronic commentators, chloroquine phosphate. The sulfate and dihydrochloride are also used.
Chloroquine phosphate/(etc.) and hydroxychloroquine are used similarly in medicine and both have in vitro activity against the SARS and COVID-19 viruses and some reports of efficacy in COVID-19 patients, including gravely ill ones; hydroxychloroquine may be more effective against COVID-19 but both chloroquine and hydroxychloroquine have been and are being used right now.
So what’s with this “fish tank cleaner?”
Chloroquine phosphate isn’t an aquarium cleaner per se, but it kills some organisms that cause some fish diseases and I think mung in the tank.
If you’re a fish fancier, you already probably know more about this than I do, if it’s just your satiable curiosity, Professor Google will tell you more than you want to know.
So what were these people doing with it on their shelf?
Ag and veterinary suppliers used to be sort of loosey-goosey and sold antibiotics for animal use some of which were identical to human meds, and preppers often took advantage of this in stocking up for TEOTWAWKI. This has pretty much been shut down and you need a prescription from a veterinarian, at least to get pharmaceutical grade stuff, though you can still take your chances on eBay, or could until the last couple of days; they’ve shut down chloroquine sales as have pretty much everybody else any semi-sane person will buy from.
They took it driven by fear:
The couple — both in their 60s and potentially at higher risk for complications of the virus — decided to mix a small amount of the substance with a liquid and drink it as a way to prevent the coronavirus.
“We were afraid of getting sick,” she said.
The veterinary chloroquine products come as tablets and powder; assuming the NBC reporter got at least one thing right, “decided to mix” makes it sound as though they had the powder on hand.
Wikipedia gives this for hydroxychloroquine blood levels:
The therapeutic, toxic and lethal ranges are usually considered to be 0.03 to 15 mg/l, 3.0 to 26 mg/l and 20 to 104 mg/l, respectively. However, nontoxic cases have been reported up to 39 mg/l, suggesting individual tolerance to this agent may be more variable than previously recognized
The drug is very well absorbed and distributes pretty evenly in our body’s water, which (depending on size and body fat) is in 40 liters give or take (sometimes a lot.) So what goes in your mouth winds up in your body fluids.
Notice that there is substantial overlap between therapeutic and toxic blood levels: assuming that you have 40 liters of body water, the respective drug doses to get the above body fluid levels would be
therapeutic: 1.2 – 400 mg
toxic: 120 mg – 1040 mg (~ 1 g)
lethal: 800 mg – 4160 mg (~ 4.1 g)
These are actual measured postmortem levels in people being treated with the drug (“non-toxic” in the study meant that the dead patient was not exhibiting signs of chloroquine toxicity.) “Individual tolerance to this agent may be more variable than previously recognized” is probably understated.
It’s possible that there were some highly toxic additives in the chloroquine phosphate preparation the Arizona couple took, but fish fanciers tend not to like to put poisons in with their fish. We may learn otherwise later, but my guess is that in addition to taking a drug on inadequate indications, they took the wrong dose. It’s very, very easy to miscalculate a dose of almost anything. Lose your koi, that’s a shame. But taking it yourself?
Or maybe Arizona Man (or Woman) did do the dosing calculations right in theory and got killed by the variable tolerance.
If it had been a prepper after TEOTWAWKI, probably nobody would have known. Meanwhile, the upshot of this is that potentially useful disaster supplies are going to be harder to get.
There are a lot of things that can make you stupid. Fear is one of them.
Published in Journalism
There is no accounting for stupid. Self administering is using not a tremendous idea when dealing with a drug you are not familiar with.
I can think of circumstances in which, G-d forbid, if I had a severe lower respiratory illness that wasn’t responding to what I was doing or with no access to healthcare, say having been triaged out of the hospital as too old, and offered the choice of a bed in a gym with little or no care and dying at home…
I might take a veterinary chloroquine phosphate. But I’d for sure have to be pretty sick, and I don’t how I’d measure it since I don’t have the weighing equipment I’d want to have.
One of the reports claimed that she used a teaspoon of the stuff per glass.
Which should indicate something like 4000 mg per person.
Yeah.
Note also that only about 75% of it gets absorbed into the body, so they were “only” exposed to a still-usually-lethal dose.
The other issue is that people keep talking about the side effects – but fail to mention that most of the severe side effects are very rare, to the point where this commonly-used and long-studied drug lists those effects as “incidence not known” (in other words, probably not real side effects, just coincidences) Most of them are “delayed,” meaning that it takes years of use to show up, like the retinopathy that usually shows up literally after decades of use.
Thanks, I hadn’t seen that dose. A teaspoon can cover a multitude of sins. Or overdoses. And as all Americans know, if a little is good, more is better.
Furthermore, since the self-medicators were older — in the autumn of their years (autumn is by nature of the melancholic temperament, being cold and dry) as they grow closer to their long term residence in the earth (cold, dry) their bodily moisture diminishes and a dose of a drug that dissolves in water can be unexpectedly powerful.
Thanks. I got my info from drugs.com, which has this:
Would Gin and Tonic have any therapeutic effect?
Anyone know the specifics of the aquarium sanitizer Chloroquine phosphate?
The recommenced human dose of Chloroquine is about 1 gm ( 600mg of the base).
Second both Chloroquine and Hydroxychloroquine can cause a fatal cardiac arrhythmia called Torsades de Pointes. it’s from of ventricular tachycardia. Patients with preexisting cardiac disease are most at risk, but a huge number of drugs can interact with there two medications and cause QT prolongation which can cause the arrhythmia. Among them are Zithromax, another drug that most of the protocols are mixing with the Chloroquine and hydroxychloroquine. So theses protocols are not without risk.
Now add another drug from the long list of QT prolonging medications and your risk increases more.
This is not something anyone should attempt without a physician.
Or not something anyone should attempt when there is a physician
I could see having a jar of fish tank cleaner around for when none of the above is true. But I’d for sure have calibrated a measure so I could administer known doses, or as close as I could get, anyway. And a printed copy of info on human use, including dosing, adverse effects, and so on.
Heck, I’ve got a hard copy of Alton’s Antibiotics and Infectious Disease: The Layman’s Guide to Available Antibacterials in Austere Settings on my “read soon” pile. Chloroquine isn’t in it. He does suggest some vet meds, though, including some fish antifungals.
And I’m smart enough not to try this at home before TEOTWAWKI; I’m actually thinking that Arizona Man may have construed the news to mean that the world is about to end.
James Thurber’s Get Ready Man was a comic character; ours are all over the internet.
I keep seeing references to QT prolongation and other cardiac issues, but when you start digging, two things turn up:
1) It’s rare. Very low chance of it happening, and it’s easy to see if you’re looking for it.
2) When it does happen, it’s usually after long term use (on the order of months to years) and/or very high doses.
There have been a couple of cases where people have had problems on the short term, but they’re even more rare than the chronic use cases, and always involved things like preexisting heart conditions and a list of other meds as long as your arm.
Balance all of that versus the risk of having someone with any of a long list of diseases and conditions come down with a serious case of Wuhan pneumonia. I have a good friend who underwent quintuple bypass surgery last year (yes, you read that right, no it’s not a typo), and the thought of him catching a bad case of it fills me with terror – because he won’t make it.
Absolutely. But that’s a different case than the sad story of the couple taking a veterinary preparation of chloroquine — in a toxic to lethal dose — because they were afraid.
There’s a whole series of gradations in between, too.
I am a nurse.
Unless you are a DVM, MD, Pharm D., and NP, you should not be attempting any of this. It is a bad idea, prepper or not. I mess with drugs sometimes, I’ll admit it. But I do it knowing that 1) I’m being a home chemist and 2) I have my dad (a Pharm D.) on call along with other medical professionals. The dosings and mixings that I occasionally undertake are under medical advice or at least medical awareness.
People need to stop thinking they’ve figured out some clever trick.
You are not more clever than the drug companies. Their drugs are relatively safe for a reason. You are not finding some hidden cure for Covid-19 or cancer. No, lavender oil will not save you. Smudging with sage is antibacterial but not antiviral.
So, in sum: people need to stop thinking they’re smart.
My attitude is that it’s at least in theory good to be prepared for when
There are none of the practitioners you listed and/or
There is a shortage of meds, PPE and medical supplies
For example, in the category of really bad stuff you can prepare for, can’t predict and can’t prevent except by moving,
There was an estimated 7.9 quake in San Francisco on April 18, 1906
In such a situation, you might be able to use your supplies to barter for care if there are medical professionals available, to barter for other goods and services, and if all else fails you can do your best with the meds you have because it’s the least bad alternative.
The local authorities advise us to have food, water, means of communications, essential medications and other necessities available. Recommended amounts range from 3 days to 3 months or more. Forming and maintianing social networks in your immediate surroundings at work and home is also part of the recommendations.
I needed antibiotics for an infected puncture wound several years ago. I took advantage of the available care. If there had been no care available, I would have been glad to have a stash of the cephalosporins I was prescribed.
This is not something that most physicians should supervise, either. Me, for example. I don’t need to give anyone torsaides des pointes, which is one of the three arrhythmias that this gynecologist remembers how to read on an ECG (A fib and V fib being the others)
God only knows what else was in that fish tank cleaner. But looking at the very first fish tank cleaner which comes up when I google it, I see CAUTION … HARMFUL IF SWALLOWED…WEAR WATERPROOF GLOVES…WASH THOROUGHLY WITH SOAP AND WATER AFTER HANDLING…
So does the second one. So does the third one. These are algaecides. They are meant to kill algae. Any fool can imagine that they could have toxicity in large doses. There’s a reason that pills are tiny.
And for Pete’s sake, these folks weren’t even sick! No one has touted this as a preventive.
This ain’t Mr Trump’s fault. This is the media’s fault, the panic-mongers’ fault. This is another death due to the hysteria, due to the fear engendered in a couple of foolish old folks.
And no, I’m not being ageist, being 63 myself.
This discussion reminds me of an old DocJay post comparing Donald Trump’s signature to Torsades de Pointes . My response was this:
This is an interesting paper.
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176
It fits with George Eby’s old work on ionizable zinc (in real life that’s zinc acetate and, about half as good, zinc gluconate) helping with colds (many of which are coronaviruses, heck probably some “colds” are mild COVID-19) when topically applied to the tissues of the throat.
Like this:
You want big, hard lozenges that take 10-20 minutes to dissolve, and don’t have any extraneous stuff in them. The zinc salt, dextrose to hold it together, and no fruit or anything like that. With the acetate, 15-20 mg of elemental zinc as the acetate every couple of hours; with the gluconate about twice that amount of zinc per dose.
This is to be done when you know you’ve been exposed or early in the illness.
This fits my criteria for application: A necessary (in this case micro) nutrient that is commonly underconsumed, which has plausible mechanistic support and some moderately good trials (and in this case, when negative results in some (not exact) replication attempts are explainable by the mechanism) and which is available in a dosage form like that of the positive trials.
There is an important caveat: Do not use these at that level for routine zinc supplementation. 1-3 days max.
From one of Rodin’s threads:
For some information on the degree of toxicity / side effects of hydroxychloroquine, see here. They added a reference to COVID-19 since I last viewed the page. Basically, they are saying you have to go off label, which doctors do all the time.
Numbers and dosing.
When the first pocket calculators came out, they had little tiny problem: if you ran the same calculation three or four times, you didn’t always get the same answer three or four times. This was considered to be suboptimal for doing science. So was only being able to do arithmetic, and not be able to do trig functions and roots and exponents and other sciency things.
So I kept my slide rule.
But in 1972, Hewlett Packard came out with the HP-35 and then, a year later when I took undergraduate physical chemistry the HP-45. Both were rolled out at $395 (about $2300 in 2020 Monopoly money) but the HP-35 dropped to $295 when the HP 45 came out. It was reproducible, did scientific functions, and otherwise could replace a slide rule and more. Plus it was programmable.
There was a hot discussion among pchem students. The way it came out was: if you’re going to grad school in hard science, get the calculator. If not, or if the person in question’s budget wouldn’t swing it, slide rules still ruled for a while.
One of my professors who had been playing with the calculator made an interesting point: using a slide rule efficiently meant planning your calculations ahead. That included learning to roughly precalculate how big you expected your answer to be since you had no decimal place on the slide rule. Say you’re calculating π x the square of the radius. If the radius is 6.53, you would do something like 3 x 6 x 6. That’s 108, so if your answer came out to a different order of magnitude you started scratching your head. You also set up the calculation so that you knew what units your numbers should be.
A couple of times, I’ve messed up on my digital kitchen scale and not noticed that it was set for ounces rather than grams.
Embarrassing if it’s salt and you don’t catch it. Could be lethal if its chloroquine. So could a whole lot of calculation errors. Especially if you’re not aware that they could happen, and what they might mean.
Worse things have happened by failing to account for units.
For example, the Gimli Glider, which I remember from my residency.
https://www.nytimes.com/1983/07/30/us/jet-s-fuel-ran-out-after-metric-conversion-errors.html
Don’t forget the Mars probe that crashed because one team was using English units and the other was using Metric.
When the street pharmacists make that kind of mistake their customers’ families and friends don’t usually hire a lawyer.
Or blame the President.
Some of us will never forget….
What does this acronym mean: TEOTWAWKI
I got as far as deciphering the “end of the world apocalyptic wrestler’s kava” but I am not sure what the remaining “I” would stand for.
The End Of The World As We Know It