Tinnitus, bear hunting, gin and tonic

Tinnitus = Ringing in the ears

2 main drugs have this side effect.

First = Aspirin = tinnitus is often the first sign of an overdose.

Second = Quinidine = Class A1 anti-arrythmic. This drug has quinine in it which is also found in tonic water. Quinine can be used for treating arrythmias but it can also be used for drug resistant malaria, nocturnal muscle cramps, or as an abortifacient. The tinnitus it causes is part of a group of side effects from quinine called Cinchonism.

What in the hell is Cinchonism? You know that they will not use that term on the boards but instead they will describe it and we will have to know what drug caused it or something like that. So knowing that Quinidine can cause Cinchonism does not do Jack if you can't identify the symptoms. Here they are: Ringing Ears, abdominal pain, headaches, flushing, rash, confusion, reversible hearing loss, dizzy, etc. 

Here is the Question: A man who returned from a safari in africa 6 months ago shows up at your ER feeling awful (dizzy, rash etc) and complaining of ringing is his ears. He mentions that he "caught something" while on his trip and that his primary care doctor has been trying to treat it but recently had to switch up the medications because they were not working. When you ask him what he "caught" he misunderstands you and begins to show you pictures of his hunting kills from the safari but fails to remember the disease. When you see a picture of him with a dead bear he killed, you remind him not to eat Bear liver because it has too much Vitamin A and could cause Vitamin A toxicity leading to cerebral edema and even death. He responds by saying he is going to stop eating anything with Vitamin A in it at all and you explain to him that is a bad idea because Vitamin A deficiency is associated with Nyctalopia (night blindness) and you explain that Vitamin A helps prevent metaplasia. With a confused look on his face he asks you why his ears are ringing. What common drink served in bars would you tell this patient to avoid?

A.) Schlitz 

B.) Root Beer

C.) Bloody Mary

D.) Gin and Tonic

E.) Mad Dog 50/50 

Answer = Gin and Tonic. The patient is being treated for resistant malaria with a drug that contains quinine. A side effect which his symptoms match = cinchonism is caused by quinine also found in Quinidine (class A1 anti-arrythmic). So drinking tonic water would only add to the problem. The bear liver and Vitamin A was just extra fun stuff but true!