Is Your Cocktail Making You Sick?

An office party, a violent illness and a medical mystery solved.

Comments: 145

  1. Oh my goodness. I'm so glad they figured this out for her! But I love g&t so I am very grateful I'm not allergic!

  2. I'm curious how likely it is that AI systems like IBM's Watson, with all its resources, would have the ability to reach the conclusion that an adept diagnostician like Dr. George did? The preliminary diagnoses might have been the same - and erroneous - but it was the doctor's follow-up questions which finally targeted the cause.

  3. The initial diagnosis by humans was erroneous as the AI system's would no doubt be as well. Follow-up questioning would be needed to diagnose a rare condition like this- only a poor diagnostian would jump to such an exotic conclusion from the outset and overlook hundreds of more likely causes. Careful follow up questioning would be needed. There is no reason that an AI system would not continue searching for a cause after its initial diagnosis was investigated and discounted. AI is indefatigable, and therefore indispensable, in searching for needles in haystacks.

  4. Probably not so good. At least three reasons: 1) AI is about statistical probability and good for more common diagnoses. Outliers like this might be, at best, highlighted as a remote possibility. 2) AI is only as good as the data set used for its training and a lot of data is needed. The most readily available sources are already digitized. Since wide use of quinine has been discontinued for decades, the old handwritten data on paper records is simply too expensive to digitize on a massive scale. 3) AI needs to have the diagnosis correctly made by people like Dr. George to train from its data set. If it was not made in the data set, the data would not "make the diagnosis" on its own. This is about decades old experience gained in practicing medicine that cannot be replaced and is handed down as "pearls" to young practitioners.

  5. For Dr George: is this also a possible reaction for quinidine? Similar class, also included in new medication nuedexta.

  6. Yes, this may be possible for quinidine, and possibly for many other drugs. But it is important to understand that a person with a severe reaction to quinine will not be sensitive to and have a severe reaction to quinidine. And vice-versa. This was one of the wonders of drug-induced reactions observed 50 years ago. Quinine and quinidine have the same molecular structure; they only differ in their tertiary structure, twisted in a different position – stereoisomers. They were the most common causes of drug-induced thrombocytopenia for decades, when quinidine was a commonly used cardiac drug and quinine was easily available without a prescription, and is was universally used for leg cramps. Years ago, it became clear that people sensitive to one didn’t react with the other.

  7. Yes to whether quinidine can cross-react in people who are susceptible to quinine toxicity.

  8. One other note: The blood tests to detect “drug-dependent antibodies,” such as the antibodies related to quinine described in our New England Journal of Medicine article, are only available (as far as I have been able to discover) at the BloodCenter of Wisconsin, Milwaukee. Their website is

  9. My elderly mother was given quinine for leg cramps and she ended up hospitalized in a close to death state. An aside, the hospital IMMEDIATELY removed the quinine from her prodigious drug regimen, likely realizing it might be a culprit--in any event, an unnecessary risk. She recovered.

    The quinine-prescribing doctor denied that it was the quinine that almost did her in but declined to put her back on it. About a month later my mother treated herself to a gin and tonic (forgetting that I had told her NEVER AGAIN) and voila: severe itching, rash yadda yadda.

    This is more common than you think. I never drink quinine in case I might need it for medical purposes. My mother drank gin and tonic her entire life and it was only after a threshold was passed (nightly quinine pills for leg cramps) that she reacted so violently. Don't drink tonbic and CERTAINLY don't take quinine for leg cramps!

  10. It's a rare reaction. I've had the same reaction to red wine and to shrimp (no kidney damage, luckily). That doesn't mean no one else should partake, although I don't even like to be near shrimp.

  11. Floramac - that could be a sulfite sensitivity? My mother has the same issue and shrimp and red wine are common triggers.

  12. "Is Your Cocktail Making You Sick?"

    "Recently, [dr. george] and colleagues combed through the medical literature and found 112 definite cases of allergic reactions to quinine, and 30 other probable ones. In three cases, the reactions were fatal."

    not to discount these 142 cases, but vodka and other alcohol are generally much more harmful than tonic or quinine. alcohol can be attributable to about 88,000 deaths per year in the US (x 7 years since 2009). in addition, there are even more non-fatal injuries per year attributable to alcohol intoxication.

    if she would have been intoxicated, ms. mendez might have never made it into the house or left the hospital uninjured.

    so, to answer the question: yes.

  13. And there are millions and millions of people who drink alcohol without ever suffering or causing any harmful effects. That doesn't mean that alcohol is without risk, but this article wasn't about alcohol or any of the thousands of other things that can be risky. This article was about the possible allergic effects of quinine. Whether we take them as seriously as we should or not, most of us know about the downsides of alcohol, but most of us are not aware of the potential danger, however rare, of quinine. The point of the story would have been lost if the article had gotten bogged down in a discussion of the dangers of alcohol.

  14. Nothing in the article suggests that the lady was "intoxicated." It is perfectly possible to have a drink or two at a party and remain sober, especially if you are also eating.

  15. Alcohol poisoning and an allergic reaction to quinine are two very different things and ate easily distinguishable to a physician.

  16. Most of us do far too little research about what we put in our bodies whether it's food, alcohol, supplements or medications. And then there are those interactions of seemingly innocuous substances like grapefruit juice and blood pressure medicines.

  17. It's not just blood pressure medicines. Grapefruit inhibits an enzyme that is needed to metabolize a great many medications. This can cause a buildup of the drug in the body leading to an overdose of the drug. I love grapefruit, but haven't been able to enjoy it in years. It's also worth noting that taking several drugs that utilize and are competing for that enzyme can also have the same effect.

  18. Very interesting article. I have a beef about the headline, though. It seems to be contradicted by the second to last paragraph which states, "The condition is rare, something that few people have to worry about. There is no reason for tonic lovers to stop drinking it." Yeah, I guess so, since it sounds serious enough that if you suffered from this allergy you'd either know it already or be dead!

  19. I saw a severe quinine reaction a number of years ago. Not as bad as described but with the patient in the hospital also with hemolytic anemia and thrombocytopenia-from qininine tablets when they used top be availaible for leg cramps

  20. Had a gin and tonic over Christmas and, for the first time, got a wicked stomach ache and the inevitable GI distress. This article makes me nervous! And I so loved a G&T in the Summertime...

  21. A Gin and Tonic is a highball, not a 'cocktail'. :)

  22. Not in this case. :)

    Cocktail: "A mixture of substances or factors, especially when dangerous or unpleasant" (OED).

  23. "Gin and Tonic is a highball, not a 'cocktail'" Another example for my collection of Distinctions Without A Difference. Thanks! :)

  24. Isn't gin also a potential allergen as well because of juniper berries? Or is that not true as I have read?

  25. I was thinking the same thing - gin can have quite a few ingredients added for flavoring; so anyone who reacts badly to a G&T might be better off avoiding gin as well as the tonic. Unless they have the stamina and daring to experiment on themselves. ( Most reactions OC don't result in the small blood vessel damage and purpura that MS Mendez suffered)

  26. Thought read it in the NYT a few years ago about an Englishwoman who was allergic to gin tonic several years ago. And the same culprit. But she got hit the second time after developing some immune response.

    But irrespective of the cause, from the Chinese medicine POV, back pain, especially lower back, sans muscular reasons like pulling something, is a clear sign of kidney problems. That should be addressed the 1st time she got to EM

  27. Quinine is still widely used in Africa and elsewhere for the treatment of malaria in injectible form. I wonder if this reaction is happening there as well, but diagnosed as something else? Or thought of as a death from malaria? It causes other side effects, e.g. hearing problems, ringing in the ears, etc. but in general when it's used, it is lifesaving. Hmm.

  28. The Mick Jagger of the hospital??? How about Albert Schweitzer or the the Alexandre Yersin or the Louis Pasteur or the Alexander Fleming?

  29. To Dr George: I recently had a severe allergic reaction to Levaquin which caused bilateral Achilles tendon ruptures and chronic tendonitis and central nervous system damage. Levaquin and Cipro are fluoroquinolones. How similar are those "quin"s to quinine?

  30. Completely different classes of molecules. Both are small molecules but quinolones are used to treat bacterial infections, whereas quinine, in addition to being drunk with gin, as the articles states, is used as an anti-malarial (viral). You can see their structural differences if you look them up. That said, tendon ruptures are a known rare adverse effect of quinolones; I'm sorry that you were in that unlucky 0.1%.

  31. Actually, malaria is caused by a single celled organism that is NOT a bacteria or a virus. And tendon rupture with floroquinolones is not that rare.

  32. Ouch! A year back I switched my evening drink to diet tonic water (minus the alcohol) over ice. Refreshing, bubbly, almost as good as a beer. I've been thinking I need to stop this, but have noted a real reluctance to quit. Is there any chance quinine is actually addictive?

  33. what makes it 'diet'? Tonic water has no sugar.

  34. Most commercial brands I've seen contain quite a bit of caloric sweetener. For instance Schweppes offers both regular and diet form.

  35. Regular tonic water has more sugar than a Coke. Read the labels,Please, folks. As much as 38 grams of sugar thats 7.5 teaspoons per 8 oz.
    If you are going to drink diet tonic, which I do, then drink Schweppes it has saccharine not aspartame.Much less damaging for your liver.

  36. Dr. George is not Mick Jagger. In fact the inverse would be much more impressive. That Mick Jagger was known as Dr. George. Our priorities are so disrupted in this day and age. We equate thoughtful physicians with rock 'n' roll stars. Totally ridiculous.

  37. BCY123, Do yourself a favor and lighten up.

  38. Normally I don't like the lighten up "advice" but in this case... It's only a metaphor, not an attempt at validation.

  39. My first reaction was that Dr. George would be more like Dr. Gregory House.

  40. I had a strong allergic reaction to the liqueur Campari which increased over the five years it took to identify since I am only an occasional drinker. It had progressed to the Epi-Pen level by the time the culprit was found. It has been almost 30 years now and I have never had a similar reaction to a food or drink.

  41. Campari had (or may still have) coloring from beetles, and you may be allergic to insects! Do you eat other arthropods- for example, crustaceans? Be careful, because insects are the crustaceans (evolutionary derived) of the land!

  42. Cochineal was used 30 years ago and until 2006. Watch out for anything containing "Carmine," which is the same coloring. Also relevant is the presence of gentian, rhubarb, orange peel, aloe, chinotto, and cascarilla, which are all present and unpublished.

  43. I know this is about quinine, but my body started to react as I read this article. I have an intolerance to anything with alcohol in it including occasional fermented fruit juices. Needless to say I don't drink at all. Recently I ate a cabbage slaw and ended up at the emergency room with a violent migraine, nausea, vomiting, etc. The reaction is always the same. The symptoms start 6-8 hours after ingestion, are quite violent and last about 10 hours. The problem is I'm getting too old to take this reaction. I visited an allergist and he simply said I have a food intolerance. Obviously! Thank you for the article. I see how much worse it can be.

  44. You should get tested for a sensitivity to sulfites!

    My mom has the same problem. To be on the safe side, I would avoid anything with sulfites in the ingredient list until you know for sure. It's in alcoholic beverages (especially wine); fermented foods; a preservative in dried fruit, dried potato products, and shredded coconut; brown sugar; pickled vegetables like sauerkraut, etc.

  45. This is a good article. We do NOT pay enough attention to what we put into our, which was once touted as a healthy food/drink for women, now is linked to breast cancer due to its estrogen-like properties; BLV (bovine leukemia virus) which doesn't make cows sick & has been found most milk producing cows is in all our milk/dairy - it is proven to be a cause of breast cancer (article in Science Daily: but the FDA refuses to test for this virus in our food chain.... We need to take ownership and stop 'ignoring' important information about our drinks, food, etc. Doctors cannot be relied upon to find causal effects - they do not keep up with these things and are in their own box - cancer doctors don't care about the cause - they treat the disease... It is very sad.

  46. They found an association with the infection BLV and breast cancer. That doesn't mean it causes breast cancer.

  47. Leg cramps? Drink a homemade electrolyte solution of water, salt and sugar. Could bring immediate relief; it couldn't hurt.

  48. Muscle cramps can also be alleviated by upping potassium intake. Two or three bananas a week work well.

  49. Interesting article. What I don't fully understand is how the patient would have forgotten that 16 months prior she had wound up in an emergency room after experiencing similar symptoms. It seems that would have been part of her medical record, if not her memory.

  50. She didn't connect that illness to the quinine. Why would she?

  51. As an ER doctor, patients forgetting something that significant is far more common than you think!

  52. Military pilots don't drink gin-and-tonics the night before high-g maneuvers the next day, not because of the gin, but the tonic, which causes black- and white-outs at lower g's and causes disorientation to come sooner.

  53. They aren't *allowed* to have the gin either, so it's not as if they can have a martini instead...

  54. Can one suddenly develop this allergy? Is it a possible effect for anyone who uses quinine? It looks like people here are saying "Phew! I don't get that and I love my G&T" but theoretically could they be at risk, albeit it very low, at some point in their lifetime?

  55. I mean, I guess… But you could say that about anything.

  56. Well, according to some of the other commenters the condition is actually a consequence of a a blood enzyme deficiency. I wonder if that would be a hereditary condition as opposed to something that you could develop over time?

  57. I have an allergy to quinine. It causes me to develop sores inside the mouth, particularly on the inside of the cheeks. Very painful for a period of one to two weeks. The sores make it impossible to eat and difficult to speak. Doctors were unable to diagnose the problem after two bouts three years apart, luckily I was able to figure it out on my own the third time (and trigger a mild reaction a fourth time to confirm).

    Medical professionals always seem surprised when I mention my allergy. The better ones quiz me on my symptoms, how I figured it out, and how I confirmed it.

  58. Actually that type of reaction is called Steven Johnson syndrome. It is a rather rare allergic disorder and most of the time painful and fatal.

    You are also allergic to Quinelin or Palquenil. It is a medication that is used to treat autoimmune disorders.

    I had the same reaction but to Plaquenil and I called my allergist and he about flipped on the phone, "STOP IT STOP IT NOW!!"
    Never had a dr freak that quickly before. If I hadn't hd to have my teeth cleaned and the dentist pointed it out, I would have kept taking the medicine and eventually had my skin blister and fall off...

  59. "Quinine is a popular remedy for treating leg cramps"?

    Everybody except the ripoff medical community knows placing an ordinary bar of soap near your legs prevents night leg cramps. Put the bar in your sock, pajamas or underwear, problem solved.

  60. I regret to say that providers aren't allowed to prescribe placebos. Many of them work, at least for some.

  61. Its not strange that people would try quinine it to relieve leg cramps. Its a muscle relaxant for many people.

  62. Which would work best? Dial, Irish Spring, Lava?

  63. This is one of the saddest stories I've ever read. G+Ts are the perfect summer cocktail. What a shame that some people can't drink them!

  64. And a lot more people just love a PB & J, but peanuts would kill them. Allergies exist. To nuts, dairy, grains, etc. All more common substances than quinine.

  65. Gin, fizzy water, and lime is a good alternative, one that avoids the unnecessary (comparatively speaking) calories of the tonic.

  66. I agree...sad story. G & T's my favorite summer drink. Now I'm afraid to drink tonic after reading this. And the end of the article says "tonic water lovers don't stop drinking tonic water." Well this happened to her suddenly. Just like myself who had been stung many many times by bees over the years, when suddenly two summers ago a bee sting almost killed me. I'd hate for a gin & tonic to kill me. I guess I'll switch to gin & soda. :-( Yuck.

  67. I am surprised they sent her home the first time. These symptoms with abnormal blood results would have resulted in hospitalization where I live.

  68. A couple of years ago I had a similar allergic reaction after drinking a beverage made with calpis concentrate (calpis is a popular milk-based soft drink in Japan) manufactured in Mexico. Or perhaps it was food poisoning. In any case, I suffered vertigo and extreme vomiting after consuming the beverage. Any relation to a quinine allergy?

  69. Don't get sick in Oklahoma.

  70. Baptist Integris Medical Ctr has some of the best doctors & nurses I've ever seen. I had a serious illness in 2009 (Castleman's disease) I received excellent care. They also took great care of my grandmother when she was there. Oklahoma has its share of problems, but it's not all bad.

  71. Really? She was properly diagnosed and lived, even though she had no idea what she drank/ate/did, and was mostly unhelpful in providing historical information to the doctors. Doctors are scientists, not mind readers- no matter what state they practice in.

  72. I got sick in Oklahoma a number of years ago; got excellent care and a good outcome. My ER doc was calm and knowledgeable.

  73. I have a food allergy. I carry Epipens and Benadryl. Is this person now carrying anything like that? The article doesn't say.

  74. I don't think this is an allergy in the traditional sense of the word. So Benadryl and Epi pen would not work.

  75. I love Denise's articles, they are so great and informative!

  76. Why not an allergy to quinine? It comes from a tree after all, and a lot of people have allergies to tree pollens, though we don't often eat trees.

  77. Quinine for leg cramps? Eat bananas. Potassium prevents cramping. Almost any bicycle rider who has ridden long distances will tell you that.

  78. As a former dialysis patient, I had to watch my potassium intake very carefully, and bananas are not close to the top of food with lots of potassium. A baked potato, for example, has almost twice the potassium of a banana. Of course, it might be a little bit harder to take with you on a bike.

  79. Thirty years ago I got a job that required hours of standing each day, and very little walking. As a result I developed severe leg cramps that I self-treated with OTC quinine sulfate. This was very helpful until the day some weeks later when my dose tipped me into anaphylaxis--a very close call. Prior to this episode my blood tests were always normal but I now have a diagnosis of thrombocytopenia. Unlike the woman cited in this story, I was able to return to work the next day.

  80. The story perpetuates a common error.

    Ms. Mendez did NOT experience an allergic reaction to an allergen, but an adverse response to an antigen. Some symptoms are similar, but treatments are poles apart.

    Popping a Benadryl can bring relief to someone suffering from an allergy, but it will have little to no effect upon the same person afflicted by an adverse reaction to, say, gasoline fumes. Or quinine.

  81. Have you heard of type II, III, and IV allergies? They are different immune pathways that benedryl can't help. I have many type IV allergies that copious amounts of antihistamines do nothing for. Steroids help however.

    It's possible this quinine reaction is an allergic reaction- just not the pathway you are thinking of.

  82. These are type I, II... hypersensitivity reactions. Reactions to antigens. Only type I has some reactions in which the antigens are common allergies.

  83. Comment disappeared?

    I commented on using quinine for leg cramps. Any bicyclist will tell you, eat bananas, you need the potassium.

  84. Not all leg cramps are caused by low potassium. I eat a banana every day and it does nothing for my leg cramps. I also take magnesium which also does nothing.

  85. Try thiamine (B1). It stopped my leg cramps and the endless twitching at various points in my body I had endured for years. But talk to your doctor first for dosage recommendations. Some vitamins taken in excess can be harmful.

  86. @David Underwood Bananas never helped me. But taking calcium/magnesium/zinc/potassium sometimes does. What always seems to help, and I'm not exactly sure why, is downing Alka Seltzer in a small glass of water. Every time, like a dream.

  87. i've heard that quinine can cause tinnitus. anyone have info/experiences with this?

  88. I developed tinnitus shortly after drinking tonic water.

  89. Does this person have G6PD? It is a blood enzyme deficiency in which you are allergic to Aspirin, Ibuprofen,Sulfa and quinine. My son has it and I want to know if he should avoid tonic water.

  90. Tonic has quinine in it, so he should certainly avoid it.

  91. I have it and I avoid tonic

  92. 1. I suggest that you all read the New England Journal of Medicine article. It's rather easy to read and understand, despite being written by physicians for physicians. The biology of the reaction is very interesting.
    2. This patient has a rare type of reactive process - and it is not in any way related to the sort of hemolysis found in those with a G6PD deficiency, and is precipitated by a different pathophysiologic mechanism.
    3. Many of the responses, in addition to being irrelevant to the case at hand, contain more than a soupçon of medievalism and (to not put too fine a point on it) medical ignorance..

  93. Funny, my daughter had a very serious medical issue of "unknown " origin. She gkt so sick over the course of 3.5 weeks i thought fkr a while she mihht die. She wound up in th ER with a grand mal seizure. Doctors sad test results were inconclusive and sent us home. I know it is an adverse reaction to the Gardasil vaccine that she received a month earlier but i cannot get any doctors to even listen to me. So many people are getting seriously ill but yet no doctors will look into it. I wonder if Dr. George knows anything about gardisil poisoning?

  94. Contact the adverse vaccine reaction center to learn more.

  95. You should report this reaction to your pharmacy, the company that makes gardisil, or the FDA as a adverse reaction. There isn't much a physician can do by telling them.

    If the Gardisil was given an entire month earlier it's difficult to say whether or not it was a reaction to that (remember correlation does not equal causation). If it was within 24 hours of receiving the vaccine, you can argue it was the gardisil, likely not a month later.

  96. How do you "know" it was a reaction to the Gardasil??

  97. TTP is not an allergy. The NEJM paper linked in this article does not mention the word allergy once. Allergies and TTP present differently are treated completely differently. Have the NYT writing really gotten so lazy that it should no longer be expected to get the name of the disease you are writing about right?

  98. What is TTP????????? If you are going to criticise the Times for not giving the disease its proper name, it would be nice if you did not make the same error in your comment!!!

  99. TTP maybe the result but the allergy was the trigger. It's what the MD from OK said.

  100. I'm too lazy to google it but it is something like transient thrombocytic purpura. You get lots of clots because your platelets are overactive and thus your platelet count goes down. It's not an allergic reaction

  101. In 2013 I took quinine pills for leg cramps before a flight scheduled the following day. I collapsed within about 3 hours. I had kidney failure, developed cardiomyopathy and gained over 60lbs in 48 hours. I was hospitalized a month and had dialysis 3x a week and plasma exchanges. i also had several blood transfusions. I developed sepsis. i am very lucky to be alive, and yes - it is an allergy to quinine.

  102. You can’t possibly have gained 60lbs. In forty-eight hours without CONSUMING at least sixty pounds of SOMETHING, even water, during that period, which is, frankly impossible. The added weight cannot come out of thin air. Hyperbole will get you nowhere.

  103. She probably was given a ton of IV fluids in very short order because her BP completely bottomed out. When somebody's blood won't stay in their veins because they're having some kind of massive, systemic inflammatory response (e.g., a life-threatening allergic reaction), it's the only thing to do to keep them alive while you're working on other interventions. People that have emergent fluid replacement combined with acute kidney failure can gain a tremendous amount of weight very quickly -- it's water, not muscle or fat.

  104. @Anniika Given a pint of aqueous liquid weighs close to a pound, do you actually think she was administered 60 pints of fluid in a short period of time?

  105. I am disappointed in this headline. Good journalism seeks to educate the reader, and sells on its reputation of doing so.

    Tabloid journalism seeks to sell papers using sex, fear, and other base instincts. By using the headline, "Is your cocktail making you sick" you devolve into the realm of tabloid.

    A much better headline more befitting the Old Gray Lady would have been "Dangers discovered in quinine consumption".

  106. The point of a headline is to get the reader to read it. Don't be so persnickety.

  107. Hmmm. No. The headline in a news oriented publication should tell you the topic of the article, rather than mislead, bait. Or fool you.

  108. My husband has platelet problems and his MD told him not to drink tonic. The problems with it are becoming more well known in the medical community.

  109. I have a severe allergy to milk protein, only when I read that most New World white wines are fined through milk solids - did I realize why I had asthma. Many red wines are fined through fish bladders or egg whites - also fairly common allergens. So the headline is your cocktail making you sick, seems fair enough.I now stick to organics/vegan wines.

  110. "Ms. Mendez calls Dr. George her savior, and said his reputation as a diagnostician made him the Mick Jagger of the hospital." What is this little paragraph supposed to mean? You can't always get what you want? Sympathy for the Devil? I can't get no (satisfaction) ?

  111. He’s a rock star to her! And after being in medicine for over 40 yrs, I have seen many cases similar to this in which no one can figure out what is wrong much less how it happened. The medical field is a maze and the professional staff are detectives and we sadly are imperfect specimens. That is why diagnoses can be so very difficult.

  112. It means he is a rock star.

  113. It means he learned about booze-related conditions with Keth Richards.

  114. Glad to hear it wasn't the vodka.

  115. The only time I've ever ridden in an ambulance was after a gin and tonic. Though my symptoms weren't as severe as Ms. Mendez', I had a crash in blood pressure, a sensation of intense heat, and loss of consciousness. The doctors at the hospital couldn't diagnose it, but two years later when the same thing occurred after another drink, I swore off tonic for ever! I later discovered my brother, who lives in England, had experienced the same problem.

  116. It is probably best to regard quinine as a medicine, and avoid drinking it recreationally.

  117. Did anyone access her “electronic” medical records which is supposed to be readily accessible? This seems the doctors had to ask her about an event that had been documented months ago?

  118. Luis, the other event happened at a wedding so she may have been away. Regardless, unless the other hospital was in the same system, it is impossible to access another hospital's records unless one has permission and knows to ask for them.

  119. Happened in 2009 were electronic medical records mandatory then?

  120. Actually, a very good point in argument of why the USA needs a national health database (like many countries have).

  121. Sensationalist headline about an incredibly rare condition. If I wanted to read a tabloid, I wouldn't be wasting my money here.

  122. I think it is an informative news story. If it were tabloid, the woman would have been abducted by space aliens and force-fed gin and tonics before being returned to Earth only forever to vote Republican.

  123. Excellent article. The headline is click bait however. It would be more appropriate as “was her cocktail making her sick?”

  124. Or, "Does tonic/quinine make a very few people very sick?"

  125. Really fascinating, but it sounds like this condition resulted in numerous small strokes, which must be terribly depressing for her, given her young age.

  126. "The Mick Jagger of the hospital." This very dated reference made me smile. But then, I wondered, who currently occupies the niche carved out by Jagger in the 1960s? Maybe my children can tell me. Or maybe the position is vacant and Mick Jagger is still the iconic rock star.

  127. This is exactly why I stick with Manhattans. 2 oz Rittenhouse Rye, 1 oz Antica sweet vermouth, 3 dashes bitters, stir (don't shake) with ice, serve on the rocks or straight up, garnish with a Luxardo cherry and a wide slice of orange peal. If consumed in moderation, it is guaranteed to not make you sick, and will not be fatal.

  128. What struck me, but did not surprise me, about this case was the lack of coordination between the patient's health history databases. Without presenting details, I have found redundant the endless collection of personal health information, and like Ms. Mendez, a lack of coordination. Ms. Mendez had a similar health issue only 16 months earlier. A search of her health history would have targeted that case and led to an accurate diagnosis, one NOT requiring an expert like Dr. George. I support powerful, comprehensive computerized healthcare systems. The weaknesses are their use (limited coordination) and doctors with too little time to actually assess a patient's health database(es).

  129. Actually, I believe the pernicious effect of EHRs is not limited coordination or doctors with too little time. It is the lack of understanding of the psychological transformation of a clinician's thought process, when faced with a massive structured database. A diagnostician knows that any fact or parameter can be determinative in reaching an obscure diagnosis. Any individual patient is a complex analog organism with functional processes so numerous and interdependent that we can never fully describe the organism's entire status with any finite number of parameters. Any database is a reductive summary of the entire status, leading to the documentation of "metadata" which is thought to represent the organisms state. Yet as any competent clinician knows, those cases like quinine reactions often require knowledge of factors not captured in the usual metadata. The EHRs diminish the accessibility to qualitative deduction by burying them in either massive copy-and-paste catalogs which pass for progress notes these days, or as obscurely placed postscripts to the structured database. The result is mathematically predictable: common diseases will, on the average, be treated moderately well since the database highlights relevant parameters, individual differences will be overlooked with significantly increased morbidity/mortality. The valuable cognitive skills and experienced of the most skillful practitioners will not be valued or reimbursable, and mediocrity will prevail.

  130. The EHR records of the patients previous hospital visit, I am sure, did not contain any data about what the patient drank prior to her illness. Neither the doctors nor the patient recognized the importance of her drinking one sip of a smoothie. No, more often than not, the EHR just is non-contributory to the present illness. It still takes a thinking shrewd, and experienced clinician like Dr. George to make the right diagnosis, especially when dealing with a complex and esoteric medical problem. ****A Connecticut physician

  131. Agree. As Sir William Osler said: "Listen to your patient. He is telling you the diagnosis" Although now a days he would have had to have said "He or she". Which does not nearly sound as good

  132. Gin and Tonic has really taken a hit this past decade; first my bartender becomes a vegetarian and stops stocking Beefeater, then there's the lime disease epidemic so no lime wedges to be had, now this... What's next? A law against me seeing my glass half full?

  133. The EHR (electronic health record) combined with dumb "quality" measures has had a very negative effect on the practice of medicine. This article is a demonstration of the practice of medicine as it was meant to be: a doctor takes a careful history, does a physical exam, reviews the labs and makes a diagnosis. Instead, in the current practice of medicine, doctors are busy clicking boxes in the EHR to meet "quality" requirements. The medical "history" is copied forward from the last note and the doctor moves on to the next patient satisfied that he will get "quality assurance points" for meeting "best practices". Click a box and they toss you a piece of fish like a trained seal. As I near the end of my medical career I am not sure the practice of medicine has been improved by the advance of technology. The thoughtful diagnostician has been relegated to the status of dinosaur.

  134. was it her sticking to her guns, the reaction was almost instantaneous , or failure of the emergency room staff to take diagnostic notice of the sudden, in a flash on- set. I had a never before a sudden in a flash deep inside ache in my arm, and went to the emergency room There doctor I think refused to believe my assertions, no trauma. I went back to my car where it happened. Nothing within reach of the arm for it hit. Oh his assertion it was the ulna nerve ( not a brain stroke ) . was correct, but the cause not where he attributed. ( a pinch in the neck)

  135. This is so strange. I used to drink vodka and tonic regularly, but I don't anymore, largely because I don't like consuming high fructose corn syrup and few brands of tonic are made with sugar. I had a six-pack of good-quality tonic water in the fridge, and decided to drink one as a soft drink. I immediately developed a strong headache. I wonder if I'm allergic too.

  136. Given our unfortunate tendency to engage in faulty self-diagnosis and overreact to exotic and rare health risks (as opposed to common and established risks like overeating, most of which which are ignored), if this gets picked up by the mainstream, premium tonics might be in for a rough spell.

  137. I have never and will never drink tonic. I have always thought that there was no reason I should consume quinine especially after researching it in the web. There are so many mixers that don't have drugs in them, why use one that does.

  138. What else can you add to vodka to make it drinkable?

  139. Soda water and a splash of cranberry juice. Lots of lime. Tonic water, besides being apparently toxic to some people, is also loaded with sugar.

  140. Rose's Lime -- make a vodka gimlet.

  141. Way back as a student I drank 10 glasses of beer, then realized I have to stop so just got me a coke and within 5 minutes got sicker than I ever was. I was allergic to Coca-Cola. Never touched it again.

  142. This had to become an experiment for me as I really wasn't sure if this was the cause of my limb swelling within minutes of consuming a gin and tonic. Over the summer I had a gin and tonic with family, even bought an organic one because I wanted to avoid the bad sweeteners. I enjoyed that gin and tonic and noticed later that my limbs were swelling, it was well into the 90s outside and I thought that just maybe it was the heat. A couple of months later I went to visits my sister in Maryland and we did not have presecco which would be my no matter what go to drink. So I mentioned to my sisiter, do you have tonic? I said okay, this is going to sound weird but I am going to conduct a test. She was with me the last time I had the swelling with my limbs and yes I had a gin and tonic. I looked at the ingredients on the back bottle, didn't know what quinine was but her husband blurted out that it use to be used to treat malaria. I'm thinking to myself that's weird... So I made myself a gin and tonic, we were busy chatting and I happen to look down at my ankles and could not believe my eyes. No sooner than that, I dumped the drink and replaced it with plenty of water to clean my system. Within a couple of hours the swelling was gone! I am just so glad that I read up on it and found some posts about the allergic reaction that Ms. Mendez experienced. No more gin and tonics for me!

  143. Re prescription quinine to prevent leg cramps: The use of quinine to prevent leg cramps was common prior to 2006 because people had the perception that it worked. Nonetheless, there were periodic case reports of serious adverse effects like the case reported here. Prescribing dropped dramatically after the FDA approved Qualaquin for malaria that year. "Unapproved" quinine products that predated the modern FDA approval process had remained on the market until that time. They were effectively forced out when the FDA required them to seek approval in order to remain on the market. Qualaquin is expensive and has a black box warning about the risk of serious adverse effects when used to treat nocturnal leg cramps. The efficacy of quinine for nocturnal leg cramps had never been established in clinical trials. Collectively, these factors dramatically reduced prescribing of quinine for the prevention of nocturnal leg cramps and may have prevented more regrettable adverse reactions to quinine like the one discussed here.

  144. I also have reacted to quinine -- in pill form for leg cramps many years ago. The first week or two that I took the pills, every night, was without any adverse effects. When the cramps went away, I stopped taking them for a few days. When I took one again, I reacted in the middle of the night with high fever, thunderclap headache, neck pain, and intense rigors -- shivering so violent and widespread it lifted me off the bed and left me, days later, with multiple sprains. Bloodwork at the ER revealed nothing but elevated WBC's. I was sent home. Two days later, I took another quinine pill, and the same horror repeated itself. This time, the ER staff wanted to perform a spinal tap, but I refused. Several IV bags later, I again returned home. It wasn't until a few days after that, that my inpatient medical coder coworkers started putting their heads together, jotting down notes of my medical history, diet, and medication list. They're the ones -- not the doctors in the ER or even my primary care physician -- who put two and two together and read to me the most likely cause, the potential side effects of quinine allergy/adverse effect which, in many ways, nearly mimic the malaria it was originally meant to treat. After throwing away the quinine, I've never experienced repeat symptoms. After reading this article, I'll be sure to be much more vigilant in avoiding it, especially in cocktails.