Alparslan KOÇ, Aytül TAŞ, Tümay ULUDAĞ YANARAL, Gülşen BİCAN, Sinan UZMAN, Mehmet TOPTAŞ

Akut izoniazid intoksikasyonu: konvülziyon, koma ve asidozun nadir bir nedeni

Yaygın kullanımına rağmen, izoniazidin intihar amaçlı alımı Türkiye’de nadir görülen bir durumdur. Konvülziyon, koma ve metabolik asidoz ile kendini gösteren alkol alımıyla birlikte olan bir akut izoniazid zehirlenmesi olgusu sunduk. Hasta intravenöz piridoksin uygulamasıyla başarılı bir şekilde tedavi edildi. Erken tanı ve yoğun bakım ünitesinde uygun tedavi akut izoniazid intoksikasyonu olan hastalarda mortalitenin önlenmesinde çok önemlidir.

Acute isoniazid intoxication: an uncommon cause of convulzion, coma and acidosis

Despite the widespread use, suicidal ingestion of isoniazid is a rare condition in Turkey. We reported a case of acute isoni- azid intoxication associated with alcohol intake presenting with convulsion, coma and metabolic acidosis. The patient was treated successfully with intravenous pyridoxine administration. Early recognation and appropriate treatment in the inten- sive care unit is very important to prevent mortality in patients with acute isoniazid toxicity.

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Shannon MW, Lovejoy FH Jr. Isoniazid. In: Haddad LM, Winchester JF (eds). Clinical Management of Poisoning and DrugOverdose. 2nd ed. Philadelphia: Saunders, 1990: 970-5.
Romero JA, Kuczler FJ. Isoniazid overdose. Recognition and management. Am Fam Physician 1998; 57: 749-52.
Cameron WM. Isoniazid overdose. Can Med Assoc J 1978; 118: 1413-5.
Sullivan EA, Geofffroy P, Weisman R, Hoffman R, Frieden TR. Isoniazid poisonings in New York City. J Emerg Med 1998; 16: 57-9.
De Lara ACF, Moral PGL, Cuison RJ. Isoniazid overdose at the Santo Tomas University Hospital-Clinical Division: a seven ye- ar review. Phil J Internal Med 1997; 35: 195-200.
Ozbay B, Sezgi C, Altinoz O, Sertogullarından B, Tokgoz N. Evaluation of tuberculosis cases detected in our region betwe- en 1999 and 2003. Tuberk Toraks 2008; 56: 396-404.
Topcu I, Yentur EA, Kefi A, Ekici NZ, Sakarya M. Seizures, me- tabolic acidosis and coma resulting from acute isoniazid into- xication. Anaesth Intensive Care 2005; 33: 518-20.
Nolan CM, Elarth AM, Barr HW. Intentional isoniazid overdo- sage in young Southeast Asian refugee women. Chest 1998; 93: 803-6.
Tai DY, Yeo JK, Eng PC, Wang YT. Intentional overdosage with isoniazid: case report and review of literature. Singapore Med J 1996; 37: 222-5.
Agrawal RL, Dwivedi NC, Agrawal M, Jain S, Agrawal A. Ac- cidental isoniazid poisoning-a report. Indian J Tuberc 2008; 55: 94-6.
Tajender V, Saluja J. INH induced status epilepticus: response to pyridoxine. Indian J Chest Dis Allied Sci 2006; 48: 205-6.
Martinjak-Dvorsek I, Gorjup V, Horvat M, Noc M. Acute isoni- azid neurotoxicity during preventive therapy. Crit Care Med 2000; 28: 567-8.
Santucci KA, Shah BR, Linakis JG. Acute isoniazid exposures and antidote availability. Pediatr Emerg Care 1999; 15: 99- 101.
Dattani RG, Harry F, Hutchings AD, Routledge PA. The effects of acute ethanol intake on isoniazid pharmacokinetics. Eur J Clin Pharmacol 2004; 60: 679-82.
Chin L, Sievers ML, Herrier RN, Picchioni AL. Potentiation of pyridoxine by depressants and anticonvulsants in the treat- ment of acute isoniazid intoxication in dogs. Toxicol Appl Pharmacol 1981; 58: 504-9.
Lovecchio F, Curry SC, Graeme KA, Wallace KL, Suchard J. Intravenous pyridoxine-induced metabolic acidosis. Ann Emerg Med 2001; 38: 62-4.
Panganiban LR, Makalinao IR, Corte-Maramba NP. Rhabdom- yolysis in isoniazid poisoning. J Toxicol Clin Toxicol 2001; 39:143-51.