I thought I had heard it said that airline pilots could not drink tonic
water for several hours before flying.  I found through Google that quinine
is often a feature of aeroplane crashes, though mostly in high doses as a
prophylactic or treatment for leg cramps.   However there is a comment in
the first snippet below on tonic beverage drinkers.  Hm, perhaps I would
re-think a 7 year old drinking tonic water on a regular basis.....

The articles I found focus mainly on hearing changes, though there are other
side effects to quinine.   Hale talks about insignificant doses in
breastmilk even when the mothers' plasma levels reached 8 mg per litre, ie
0.008 mg/ml, on actual quinine treatment.  As opposed to the crashed airline
pilots blood serum levels of 0.2 mg/ml; it does not actually say that those
deceased pilots drank only tonic water, though the juxtaposition of the two
sentences suggests it. Hale's information suggests not, so maybe it's just
one of those "good stories".

The Hale information implies that for a breastfeeding mother a gin and tonic
wouldn't hurt.  However I would prefer to recommend vodka and orange juice -
all that vitamin C...... :-)

Jacquie

http://ivertigo.net/ototoxicity/otother.html

Quinine ototoxicity is manifested both by auditory and vestibular
dysfunction. Toxicity is called cinconchism and presents as deafness,
vertigo, tinnitus, headache, nausea, and visual loss. Transient hearing
loss, usually a first side effect, occurs a few hours after initiating
high-dose therapy as, for example, in the treatment of malaria. With
prolonged treatment for malaria, 20% of patients can be expected to suffer
hearing loss.45 The sensorineural hearing loss is usually reversible
bilaterally and symmetric, particularly affecting the high-frequencies
first. Tinnitus, similar to that, is caused by salicylates. Vestibular
effects of quinine are also recognized. Low serum quinine concentrations,
which may occur among tonic beverage drinkers, may lead to clinically
significant vestibular changes. Blood quinine levels of 0.2 mg/ml found in
pilots who died in aviation accidents suggested that quinine toxicity may
have played a causative role.46 Prolonged administration of high-dose
quinine in many patients led to loss of outer hair cells. There may also be
an effect on cochlear blood flow.47

http://www.ntsb.gov/ntsb/brief.asp?ev_id=20001211X11088&key=1
The side effects of quinine can include disturbances of vision, hearing, and
balance. Disturbances of balance have been noted even at low doses, and the
use of quinine by pilots is usually contraindicated, as it may contribute to
spatial disorientation under some conditions.

http://www.findarticles.com/p/articles/mi_m0BUM/is_1_82/ai_97754556
Quinine. Quinine ototoxicity is often grouped together with salicylate
ototoxicity, but they are quite different in that the former manifests not
as a flat hearing loss but rather as a high-frequency sensorineural hearing
loss. Moreover, quinine toxicity is associated with some meaningful
vestibular toxicity, which is not generally seen in salicylate ototoxicity.
Quinine-induced vestibular toxicity can be reversed with prompt recognition
and treatment, but long-standing toxicity is frequently irreversible.

Initially, quinine-induced ototoxicity was seen primarily in patients with
malaria, which is not now a major problem in the United States. However,
quinine is being increasingly prescribed by primary care physicians for the
treatment of leg cramps, and there are some reports of significant
vestibular dysfunction as a result. Because of quinine's effect on the
vestibular system, the military now prohibits pilots from flying their
planes within 48 hours of taking the agent.

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