Blackwater fever

Contraindications Hypersensitivity to quinine (possible cross-sensitivity to quini-dine), G-6-PD deficiency, tinnitus, optic neuritis, history of thrombocytopenia during previous quinine therapy, blackwater fever... 

Blackwater fever is a rare severe illness that includes marked hemolysis and hemoglobinuria in the setting of quinine therapy for malaria. It appears to be due to a hypersensitivity reaction to the drug, although its pathogenesis is uncertain. 

Three new, closely related indolosesquiterpene derivatives have been isolated from the stems of Polyathia suaveolens Engl, et Diels, a Nigerian tree which affords a decoction used in native medicine for the treatment of blackwater fever and stomach disorders.116 Mainly on the basis of their n.m.r. spectra and interconversions, polyavolensinol has been attributed the structure (7), polyavolensin is the corresponding acetate (8), and polyavolensinone is the related ketone a completely unequivocal proof of these structures, however, has not been provided. 

Acute intravascular hemolysis with renal involvement and even renal insufficiency can occur with quinine and can follow relatively small doses. Quinine-induced hemolysis has probably played a role in the clinical syndrome of blackwater fever in the past. 

Quinine is contraindicated in patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, optic neuritis, tinnitus, or a history of blackwater fever and thrombocytopenia purpura. The symptoms of overdosage are tinnitus, dizziness, skin rash, and GI disturbance (intestinal cramping). With higher doses, cardiovascular and CNS effects may occur, including headache, fever, vomiting, apprehension, confusion, and convulsions. 

A) Blackwater fever occurs in patients sensitized to chloroquine... 

Massive intravascular hemolysis (blackwater fever) is now a rare complication of the treatment of malaria with quinine. Blackwater fever does not occur in the few patients who may be sensitive to chloroquine. The answer is (A). 

The role of glucose-6-phosphate dehydrogenase deficiency in blackwater fever. 

Blackwater Fever A complication of malaria, falciparum characterized by the passage of dark red to black urine. [NIH]... 

Blackwater fever Malaria caused by Plasmodium falciparum that results in jaundice and kidney damage. 

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