Isoniazid intoxication presenting as status epilepticus, hyperglycemia, severe metabolic acidosis and hepatotoxicity

Yıl 2011, Cilt: 2 Sayı: 4, 45 - 47, 01.10.2011

Evrim Çakır Murat Çınarsoy Selma Karaahmetoğlu Erdal Eskioğlu

Öz

Isoniazid (isonicotinic acid hydrazide [INH]) is an antimicrobial that
has been used as a firstline agent for prophylaxis and treatment of tuberculosis.
Since isoniazid is increasingly being used to control the
spread of tuberculosis, physicians must be aware of its potentially fatal
effects. An acute overdose is potentially fatal and is characterized
by the clinical triad of repetitive seizures unresponsive to the usual
anticonvulsants, metabolic acidosis with a high anion gap and coma.
The diagnosis of INH overdose should be considered in any patient
who presents to emergency medical services with the triad. We report
a patient presenting with multiple generalized tonic clonic convulsions
with severe metabolic acidosis and hyperglycemia as a manifestation
of INH toxicity

Anahtar Kelimeler

isoniazid, intoxication, tonic clonic convulsion, metabolic acidosis, hepatotoxicity

Status epileptikus, hiperglisemi, ciddi metabolik asidoz ve hepatotoksisite ile prezente olan izoniazid intoksikasyonu

Öz

İzoniazid (izonikotinik asit hidrazid [INH]) bir antimikrobiyal
olup tüberküloz profilaksi ve tedavisinde ilk seçenek ajan olarak
kullanılmaktadır. Tüberkülozun yayılımını kontrol altına almada
İzoniazid’in artan kullanımından dolayı klinisyen ilacın potansiyel
fatal etkilerinin farkında olmalıdır. Akut yüksek doz antikonvulzanlara
cevap vermeyen tekrarlayıcı nöbetler, yüksek anyon gapli metabolik
asidoz ve koma ile seyreden triad ile karakterizedir ve potansiyel
fatal olabilir. Izoniazid yüksek doz alımı acil servise bu triadla gelen
her hastada düşünülmelidir. Biz de burada multipl, jeneralize, tonikklonik
nöbet, ciddi metabolik asidoz ve hiperglisemi ile prezente olan
INH toksikasyonu vakasını sunduk.

Anahtar Kelimeler

izoniazid, intoksikasyon, tonik klonik konvulzyon, metabolik asidoz, hepatotoksisite

Kaynakça

• Mechem CC, Toxicity, Isoniazid. E Medicine Specialties-Emer- gency Medicine-Toxicology. Updated: Mar 21, 2009.
• Romero JA, Kuczler FJ. Isoniazid overdose: recognition and man- agement. Am Fam Physician 1998;57(4):749-52.
• Gokhale YA, Vaidya MS, Mehta AD, Rathod NN. Isoniazid toxic- ity presenting as status epilepticus and severe metabolic acidosis. J Assoc Physicians India. 2009;57:70-1.
• Shannon MW, Lovejoy FH Jr. Isoniazid. In: Haddad LM, Win- chester JF, eds. Clinical management of poisoning and drug over- dose. 2d ed. Philadelphia: Saunders, 1990:970-5.
• Mandell GL, Sande MA. Antimicrobial agents, drugs used in che- motherapy of tuberculosis and leprosy In: Goodman Gilman A, Goodman LS, Rall TW, et al. The Pharmacological Basis of Thera- peutics. 8th ed, New York. Mc Millan 1991.
• Alvarez FG, Guntupalli KK. Isoniazid overdose: four case reports and review of the literature. Intensive Care Med 1995;21:641-4.
• Yarbrough BE, Wood JP. Isoniazid overdose treated with high- dose pyridoxine. Ann Emerg Med 1983;12:303-5.