Treatment of Refractory Seizures in Massive Isoniazid Overdose

Acute isoniazid poisoning simulating meningoencephalitis

“…On rare occasions, peritoneal or hemodialysis may be required. 6 Our patient demonstrated the classic triad of severe acidosis, coma, and convulsions, as well as hyperglycemia, ketonuria, and elevated liver enzymes. Serum lactic acid was not measured.…”

Acute isoniazid poisoning

“…A total dose of thiopentone 1.4 g in 24 h was given. The patient remained haemodynamically stable and the blood gases on IPPV at an Ro, 0.6 were: pH 7.34, PO, 24.48 kPa, Pco, 5.27 kPa, BE-4.7 mmo1.l-' and Sao, 97%. At this stage chest X ray, haematological and biochemical investigations and fundoscopy of the eye were all normal.…”

“…The management of patients with acute isoniazid poisoning is aimed at gut decontamination, control of convulsions, correction of tissue hypoxia and administration of pyridoxine [5]. Isoniazid is known to inhibit parahydroxylation of phenytoin, therefore phenytoin toxicity may occur [2], which limits its r d e in the treatment of acute INH poisoning.…”

“…Isoniazid is known to inhibit parahydroxylation of phenytoin, therefore phenytoin toxicity may occur [2], which limits its r d e in the treatment of acute INH poisoning. Isoniazid-induced seizures are refractory to usual anticonvulsants therefore thiopentone is preferred [5]. Pyridoxine, which is a specific antidote.…”

Seizures caused by pyridoxine (vitamin B6) deficiency in adults: A case report and literature review

“…Severe acute neurotoxicity of INH overdose is characterised by recurrent seizures, profound metabolic acidosis, coma and even death (24)(25)(26)(27)(28)(29)(30). INH is thought to cause seizures by interfering with γ-aminobutyric acid synthesis.…”