Akut izoniazid intoksikasyonuna bağlı nöbet

Year 2018, Volume: 11 Issue: 3, 361 - 364, 28.09.2018

Arife Erdoğan Serdar Beden Mümin Alper Erdoğan Vermi Değerli İsmet Parlak

https://doi.org/10.31362/patd.451578

Abstract

İzoniazid (İNH) tüberküloz tedavisinde ve profilaksisinde yaygın olarak
kullanınlan bir antitüberküloz ilaçtır. Akut İNH zehirlenmesi, standart
antikonvülsanlara dirençli nöbetlere, sodyum bikarbonat tedavisine dirençli
yüksek anyon açıklı metabolik asidoza ve komaya neden olur. Alınan İNH dozuna
eş miktarda parenteral piridoksin verilmesi en etkili tedavidir. Tedavi
edilmemiş vakalar ölümle sonuçlanabilir. Biz akut İNH zehirlenmesi nedeniyle
jeneralize tonik klonik nöbete sekonder sol omuz dislokasyonu ve fraktürü
saptanan 24 yaşında bir kadın hasta olgusunu sunuyoruz. Senkop nedeniyle acil
servise başvuran hasta muayene sedyesine alınır alınmaz nöbet geçirdi, izlemde
bilinç bulanıklığı ve kan gazında metabolik asidoz saptandı. Klinik gözlem ve
semptomatik tedavi sonrası bilinci açılan hastanın tüberküloz deri tutulumu
için İNH kullandığı, akşam dozunu içtiğini unutarak tekrar içtiği tespit
edildi. Hasta 24 saat acil serviste monitorize olarak takip edildi. İzlemde
nöbet olmaması, başka ek semptomların gelişmemesi ve metabolik değerlerin
düzelmesi üzerine şifa ile taburcu edildi. Sonuç olarak durdurulamayan
nöbetlerle acil servislere başvuran hastalarda, metabolik asidoz ve koma
birlikteliğinde İNH zehirlenmesi de düşünülmeli ve acil servislerde parenteral
piridoksin mutlaka bulundurulmalıdır.

Keywords

İzoniazid zehirlenmesi, konvülziyon, metabolik asidoz

Secondary shoulder dislocation and fracture due to acute isoniazid intoxication.

Abstract

Isoniazid (INH) is an antituberculosis drug which is widely used in the
treatment and prophylaxis of tuberculosis. Acute INH intoxication leads to
resistive seizure to standard anticonvulsants, high anion-clear metabolic
acidosis resistant to sodium bicarbonate treatment and coma. Parenteral
pyridoxine administration in the same amount with INH dose is the most
effective treatment. We present a case of a 24-years-old woman who diagnosed
with left shoulder dislocation and fracture secondarily to generalized tonic
clonic seizure due to acute INH intoxication. The patient who was referred to
ED due to syncope had a seizure upon examination, loss of consciousness and
metabolic acidosis was also detected. It was learned that the patient who
restored to consciousness after treatment, had used INH for skin involvement of
tuberculosis and also recieved INH again mistakenly for nighttime dose. The
patient was monitored 24 hours and discharged with a cure upon there was no
seizure in monitoring, non-development of any other additional symptoms and
because of improvements in metabolic parameters. In conclusion, it should also
be considered to have intoxication of INH in patients who referred with
unstoppable seizures, metabolic acidosis and coma, thus parenteral pyridoxine
must definitely be provided in emergency departments.

Keywords

Isoniazid intoxication, convulsion, metabolic acidosis

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