Fatal poisoning by isoniazid and rifampicin

Sridhar, A; Sandeep, Yanala; Chennu, Krishnakishore; Sriramnaveen, P; Yadla, Manjusha; Sivakumar, V

doi:10.4103/0971-4065.103930

Cited by 29 publications

(18 citation statements)

References 6 publications

(6 reference statements)

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“…This has only been described in one other INH toxicity case report, where INH was combined with rifampicin. [4] Two, and possibly all three patients, co-ingested unknown amounts of tenofovir-containing fixeddose combination tablets. Even though tenofovir is known to cause nephrotoxicity over time in therapeutic doses, no cases of acute renal failure have been reported with an overdose.…”

Section: Three Cases Of Intentional Isoniazid Overdosea Life-threatenmentioning

confidence: 99%

Three cases of intentional isoniazid overdose – a life-threatening condition

Stead

Mason

2016

S Afr Med J

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Section: Three Cases Of Intentional Isoniazid Overdosea Life-threatenmentioning

confidence: 99%

Three cases of intentional isoniazid overdose – a life-threatening condition

Stead

Mason

2016

S Afr Med J

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“…Despite the vast usage of FDC anti-TB therapy, poisoning with FDC-IR tablets is rarely reported in the literature which may be due to under reporting. However there are few reported cases on ingestion of isoniazid alone or in combination with rifampicin leading to severe morbidity and mortality from India but no cases reported from Sri Lanka [ 3 ]. Although rare, the outcome is considered to be extremely poor when the poisoning is severe and specific antidote is not readily available [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pyridoxine is the antidote for severe isoniazid poisoning and there is no specific antidote identified for rifampicin toxicity. Intravenous pyridoxine is recommended in large doses when symptoms of acute neurotoxicity develop with Isoniazid poisoning [ 3 – 7 ]. Intravenous (IV) pyridoxine is not widely available even in best of care centers and there are few reported cases of isoniazid poisoning successfully managed with oral pyridoxine in the acute setting when IV preparation is not available [ 4 , 8 ].…”

Section: Introductionmentioning

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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“…We read the article by Sridhar et al ,[1] with great interest. The authors had rightly pointed out that time is of the essence in treating patients with Isoniazid (INH) toxicity.…”

mentioning

confidence: 99%

“…[2] It is rapidly and completely absorbed from the GI tract, with peak plasma levels achieved within 20 min after ingestion. However, in the case reported,[1] pyridoxine tablets were not effective because the patient was hemodynamically unstable. In shock states, blood flow is diverted toward the vital organs; this shunting of blood reduces absorption of drugs from the intestines.…”

mentioning

confidence: 99%