A case of fatal poisoning by rifampicin

Plomp, T. A.; Battista, H. J.; Unterdorfer, H; Ditmarsch, W. C. van; Maes, R. A. A.

doi:10.1007/bf00319652

Cited by 14 publications

(6 citation statements)

References 6 publications

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“…Desacetylrifampicin comprises over 80% of the antibacterial activity of rifampicin in human bile (Acocella 1983). Others have failed to detect this metabolite in bile but have observed about 62% in human urine (Plomp et al 1981). The compound is also present in human serum (Berg et al 1987).…”

Section: Uptake Of Anionic Drugs Into Hepatocytesmentioning

confidence: 99%

Transport of organic anions in the liver. An update on bile acid, fatty acid, monocarboxylate, anionic amino acid, cholephilic organic anion, and anionic drug transport

Petzinger¹

1994

Reviews of Physiology, Biochemistry and Pharmacology

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Section: Uptake Of Anionic Drugs Into Hepatocytesmentioning

confidence: 99%

Transport of organic anions in the liver. An update on bile acid, fatty acid, monocarboxylate, anionic amino acid, cholephilic organic anion, and anionic drug transport

Petzinger¹

1994

Reviews of Physiology, Biochemistry and Pharmacology

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“…The diacetyl metabolite is less toxic and its aqueous solubility results in better elimination in bile. In general, rifampicin is well tolerated by man even in very high doses and intoxication, with fatal outcomes being exceptional [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Oral pyridoxine can substitute for intravenous pyridoxine in managing patients with severe poisoning with isoniazid and rifampicin fixed dose combination tablets: a case report

2017

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BackgroundFixed drug combination of isoniazid and rifampicin is a rare cause of poisoning even in endemic countries for tuberculosis infection. Severe poisoning can cause severe morbidity and mortality if not treated promptly. Though intravenous pyridoxine is the preferred antidote for severe standard isoniazid poisoning it is not freely available even in best of care centers. We describe a case of severe poisoning with fixed drug combination of isoniazid and rifampicin successfully managed with oral pyridoxine at national hospital of Sri Lanka.Case presentationA 22 year old, Sri Lankan female presented to a local hospital 1 h after self-ingestion of 28 tablets of fixed drug combination of isoniazid and rifampicin which contained 4.2 g of standard isoniazid and 7.2 g of rifampicin. One and half hours after ingestion she developed generalized tonic–clonic seizure with loss of consciousness. She was given intravenous diazepam 5 mg immediately and transferred to national hospital of Sri Lanka, for further care. Upon arrival to tertiary care hospital in 3.5 h of poisoning she had persistent vomiting, dizziness and headache. On examination, she was drowsy but arousable, orange–red discoloration of the body was noted even with the dark skin complexion. She also had orange–red colour urine and vomitus. Pulse rate was 104 beats/min, blood pressure 130/80 mmHg, respiratory rate was 20 breaths/min. The arterial blood gas analysis revealed compensated metabolic acidosis and mildly elevated lactic acid level. Considering the clinical presentation with neurological toxicity and the large amount of isoniazid dose ingested, crushed oral tablets of pyridoxine 4.2 g (equal to standard isoniazid dose ingested) administered immediately via a nasogastric tube since intravenous preparation was not available in the hospital. Simultaneously forced diuresis using intravenous 0.9% saline was commenced in order to enhance excretion of toxic metabolites via kidneys. She had no recurrence of seizures but had acute liver injury subsequently which gradually improved with supportive care. Her liver functions found to be completely normal 1 week after the discharge.ConclusionsPoisoning with fixed drug combination of isoniazid and rifampicin tablets is rare but can cause severe morbidity and mortality if not treated promptly. Oral pyridoxine can substitute for intravenous pyridoxine with almost similar efficacy at a low cost in managing patients with acute severe standard isoniazid poisoning in resource poor setting.

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“…The toxic effects have been described with ingestion of 9-12 g and 14-15 g of rifampicin in various situation. [56] About 70-80% of rifampicin is bound to protein and is distributed throughout body. The diacetyl metabolite is less toxic and its aqueous solubility results in better elimination in bile.…”

Section: Discussionmentioning

confidence: 99%

“…This results in accumulation of unchanged rifampicin that is more toxic and results in fatal poisoning. [56] rifampicin is not significantly removed by hemodialysis in view of large molecular weight, wide distribution in tissue, and high (80%) protein binding. However, rifampicin has rapid hepatic clearance.…”

Section: Discussionmentioning

confidence: 99%

Fatal poisoning by isoniazid and rifampicin

Sridhar¹,

Sandeep²,

Chennu³

et al. 2012

Indian J Nephrol

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Isoniazid and rifampicin are used for management of tuberculosis. Acute poisoning due to isoniazid overdose is associated with repetitive generalized tonic-clonic seizures and severe metabolic acidosis. In toxic doses, rifampicin is known to produce hepatic, renal, hematological disorders, and convulsions. Sometimes, it may produce red man syndrome. We report a case of fatal poisoning with isoniazid and rifampicin. The case was characterized by late presentation, lactic acidosis, and renal failure.

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A case of fatal poisoning by rifampicin

Cited by 14 publications

References 6 publications

Transport of organic anions in the liver. An update on bile acid, fatty acid, monocarboxylate, anionic amino acid, cholephilic organic anion, and anionic drug transport

Transport of organic anions in the liver. An update on bile acid, fatty acid, monocarboxylate, anionic amino acid, cholephilic organic anion, and anionic drug transport

Oral pyridoxine can substitute for intravenous pyridoxine in managing patients with severe poisoning with isoniazid and rifampicin fixed dose combination tablets: a case report

Fatal poisoning by isoniazid and rifampicin

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