Arife ERDOĞAN, Serdar BEDEN, MÜMİN ALPER ERDOĞAN, Vermi DEĞERLİ, İsmet PARLAK

Akut izoniazid intoksikasyonuna bağlı nöbete sekonder omuz dislokasyonu ve fraktürü

zoniazid (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.

Secondary shoulder dislocation and fracture due to acute isoniazid intoxication

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. Untreated cases may result in death. 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.

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