Coma caused by isoniazid poisoning in a patient treated with pyridoxine and hemodialysis

Tai, Wei-Ping; Hui, Yi

doi:10.1007/s12325-008-0098-7

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…A total of 949 articles were identified after removal of duplicates. Forty‐three articles were included for qualitative analysis: two animal experiments, 92,93 seven pharmacokinetic studies, 21,30,94–98 and 34 case reports or case series 9–14,29,36,40,99–123 . No randomized controlled trials or observational studies were identified.…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Isoniazid toxicity from self‐poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence‐based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty‐three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as “Moderately Dialyzable” by hemodialysis for patients with normal kidney function (quality of evidence = C) and “Dialyzable” by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).

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Section: Resultsmentioning

confidence: 99%

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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“…Hemodialysis should be considered in cases that do not respond to large doses of pyridoxine, anticonvulsants, or bicarbonate therapy (8).…”

Section: Discussionmentioning

confidence: 99%

What is the Cause of Seizure: Isoniazid Poisoning or Epidural Hematoma? A Case Report

Şafak¹,

Karabulut²,

Çorbacıoğlu³

et al. 2016

JAEMCR

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Introduction: Isoniazid (INH) is the primary drug that is widely used in the treatment of tuberculosis. Because of the decrease in the incidence of tuberculosis, the usage of INH and its associated intoxications have decreased with time. In this case, we present a patient who was admitted to the emergency department (ED) with seizure attack, wherein it could not be determined whether the cause of the seizure was INH poisoning or epidural hematoma. Case Report: A 26-year-old woman was brought to the emergency department because of self-poisoning with an over-dosage of INH. On arrival at the ED, she had a seizure. Arterial blood gas analysis revealed lactic acidosis and hyperglycemia. At the same time, she had a head trauma, and brain computed tomography demonstrated epidural hematoma; thus, 18 mg/kg phenytoin was initiated for seizure prophylaxis. Intravenous pyridoxine treatment was planned for intoxication of INH; however, the treatment was not available because of the absence of this drug in our local region. Conclusion: As in our case, if the patient is concurrently diagnosed with epidural hematoma in addition to INH poisoning, it can be difficult to discriminate the cause of seizure. Although lactic acidosis, hyperglycemia, and seizure were defined as a classical triad for INH poisoning, this triad can be observed in many types of seizures.

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“…Isoniazid is a rare but life‐threatening overdose that causes recurrent seizures, coma, and metabolic acidosis. There are few reported cases, with limited evidence for treatment including the effectiveness of dialysis . We report a massive overdose treated with pyridoxine and dialysis, and describe the pharmacokinetics in overdose.…”

Section: Introductionmentioning

confidence: 95%

“…There are few reported cases, with limited evidence for treatment including the effectiveness of dialysis. [2][3][4][5][6][7] We report a massive overdose treated with pyridoxine and dialysis, and describe the pharmacokinetics in overdose.…”

Section: Introductionmentioning

confidence: 99%

Isoniazid poisoning: Pharmacokinetics and effect of hemodialysis in a massive ingestion

Skinner

Saiao

Mostafa

et al. 2015

Hemodialysis International

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Isoniazid is a rare overdose that causes seizures and there is limited evidence to guide treatment. We report a 20-year-old female migrant who presented with recurrent seizures after ingesting 25 g of isoniazid. She was treated with activated charcoal, repeated doses of midazolam for the seizures, and given multiple doses of pyridoxine (14 mg), limited by availability. She was admitted to intensive care, and 5.5 hours post-ingestion, she was commenced on continuous veno-venous hemodiafiltration (CVVHDF). She was extubated after 24 hours and CVVHDF was ceased 6 hours later (30 hours post-overdose). Her renal function remained normal and her initial lactate was the highest at 2.3. She made a full recovery. Five plasma samples were collected before, during, and after CVVHDF, and isoniazid was quantified with liquid chromatography-tandem mass spectrometry. A pharmacokinetic analysis of time-isoniazid concentration data was fitted to a two-compartment model with first-order input (with fixed ka ) with the effect of CVVHDF modeled as a time-dependent covariate. This suggested that there was initially good clearance with CVVHDF (4 times endogenous clearance), which rapidly declined within hours.

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Coma caused by isoniazid poisoning in a patient treated with pyridoxine and hemodialysis

Cited by 12 publications

References 9 publications

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

What is the Cause of Seizure: Isoniazid Poisoning or Epidural Hematoma? A Case Report

Isoniazid poisoning: Pharmacokinetics and effect of hemodialysis in a massive ingestion

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