What is the Cause of Seizure: Isoniazid Poisoning or Epidural Hematoma? A Case Report

Öz

Introduction: Isoniazid (INH) is the primary drug that is widely used in the treatment of tuberculosis. Because of the decrease in the incidence of tuberculosis, the usage of INH and its associated intoxications have decreased with time. In this case, we present a patient who was admitted to the emergency department (ED) with seizure attack, wherein it could not be determined whether the cause of the seizure was INH poisoning or epidural hematoma.Case Report: A 26-year-old woman was brought to the emergency department because of self-poisoning with an over-dosage of INH. On arrival at the ED, she had a seizure. Arterial blood gas analysis revealed lactic acidosis and hyperglycemia. At the same time, she had a head trauma, and brain computed tomography demonstrated epidural hematoma; thus, 18 mg/kg phenytoin was initiated for seizure prophylaxis. Intravenous pyridoxine treatment was planned for intoxication of INH; however, the treatment was not available because of the absence of this drug in our local region. Conclusion: As in our case, if the patient is concurrently diagnosed with epidural hematoma in addition to INH poisoning, it can be difficult to discriminate the cause of seizure. Although lactic acidosis, hyperglycemia, and seizure were defined as a classical triad for INH poisoning, this triad can be observed in many types of seizures

Anahtar Kelimeler

• Isoniazid, seizure, epidural hematoma, pyridoxine

Kaynakça

1. Eyüboğlu T, Derinöz O. Rhabdomyolysis due to isoniazid poisoning re- sulting from the use of intramuscular pyridoxine. Turk J Pediatr 2013; 55: 328-30.
2. Wood JD, Peesker SJ. The effect on GABA metabolism in brain of isonicotinic acid hydrazine and pyridoxine as a function of time after administration. J Neurochem 1972; 19: 1527-37. [CrossRef]
3. Morrow LE, Wear RE, Schuller D, Malesker M. Acute Isoniazid Toxicity and the Need for Adequate Pyridoxine Supplies. Pharmacotherapy 2006; 26: 1529-32. [CrossRef]
4. Lheureux P, Penaloza A, Gris M. Pyridoxine in clinical toxicology: a review. Eur J Emerg Med 2005; 12: 78-85. [CrossRef]
5. Caksen H, Odabas D, Erol M, Anlar O, Tuncer O, Atas B. Do not over- look acute isoniazid poisoning in children with status epilepticus. J Child Neurol 2003; 18: 142-3. [CrossRef]
6. Chin L, Sievers ML, Herrier RN, Picchioni AL. Convulsions as the etiol- ogy of lactic acidosis in acute isoniazid toxicity in dogs. Toxicol Appl Pharmacol 1979; 49: 377-84. [CrossRef]
7. Wason S, Lacouture PG, Lovejoy FH. Single high-dose pyridoxine treat- ment for isoniazid overdose. JAMA 1981; 246: 1102-4. [CrossRef]
8. Tai WP, Yue H, Hu PJ. Coma caused by isoniazid poisoning in a patient treated with pyridoxine and hemodialysis. Adv Ther 2008; 25: 1085-8. [CrossRef]

9. Santucci KA, Shah BR, Linakis JG. Acute isoniazid exposures and anti- dote availability. Ped Emerg Care 1999; 15: 99-101. [CrossRef]
10. Zell-Kanter M. Oral pyridoxine in the management of isoniazid poison- ing. Pediatr Emerg Care 2010; 26: 965.[CrossRef] JEMCR 2016; 1; 3-5