Eda KILIÇ ÇOBAN, Vasfiye Burcu DOGAN, Ali DİRİK

Ülkemizde bir status epileptikus nedeni: İzoniazid zehirlenmesi

Tüberküloz profilaksisi ve tedavisinde ülkemizde yaygın olarak kullanılan izoniazidin (INH) yüksek dozda alımı metabolik asidoz, nöbet ve koma ile sonuçlanabilir. On yedi yaşında, öncesinde nöbet öyküsü olmayan kadın hasta, acil nöroloji polikliniğimize jeneralize konvülsif status epileptikus tablosu ile başvurdu. Hastanın kan tetkiklerinde hiperglisemi, metabolik asidoz, hipopotasemi, lökositoz ve kreatinin kinaz yüksekliği saptandı. Standart antikonvülsan tedaviye nöbetlerinin yanıt vermemesi ve şüpheli izoniazid (INH) zehirlenmesi öyküsünün alınması üzerine yapılan piridoksin infüzyonu sonrası hastanın nöbetleri sona erdi. Nöbet tekrarı olmayan hastada takibinin 3. gününde karaciğer enzimlerinde ve kreatinin kinazda artış gözlendi. Sonuç olarak, ülkemizde tüberküloz nedeni ile INH kullanımı yaygındır. Bu nedenle, durdurulamayan nöbetlerle acil nöroloji polikliniklerine başvurmuş hastalarda, metabolik asidoz ve koma birlikteliğinde izoniazid zehirlenmesi mutlaka akla gelmelidir

A Cause of Status Epilepticus in Turkey: Isoniazide Intoxication

In Turkey, isoniazide (INH) is widely used for the prophylaxis and treatment of tuberculosis. Acute overdose of INH may cause metabolic acidosis, repetitive seizures and coma. A 17 year old patient was admitted to our emergency clinic with generalized convulsive status epilepticus. Her initial laboratory studies revealed hyperglycemia, leucosytosis, metabolic acidosis, hypopotasemia and high creatinin kinase (CPK) levels. Her seizures continued under standard anticonvulsive therapy. As acute toxic exposure of INH was suspected, piridoxin infusion was started. Her seizures ended. She became awake, alert and responsive. On the third day, serum transaminase and CPK levels increased. As a conclusion, INH is widely used for treatment of tuberculosis in our country. That’s why INH toxicity should be suspected in any patient with refractory seizures, hyperglycemia and metabolic acidosis

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