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Related Experiment Videos

Acute isoniazid exposures and antidote availability.

K A Santucci1, B R Shah, J G Linakis

  • 1Department of Pediatrics, Brown University School of Medicine/Hasbro Children's Hospital, Providence, Rhode Island, USA.

Pediatric Emergency Care
|April 29, 1999
PubMed
Summary

Many hospitals lack sufficient pyridoxine, the antidote for isoniazid (INH) poisoning. This deficiency leaves emergency departments ill-equipped to manage INH-induced seizures, highlighting a critical gap in emergency preparedness.

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Area of Science:

  • Emergency Medicine
  • Clinical Toxicology
  • Public Health

Background:

  • Acute isoniazid (INH) poisoning incidence has risen, necessitating prompt treatment.
  • Parenteral pyridoxine is the antidote for INH-induced seizures.
  • A 5-g pyridoxine aliquot, recommended for unknown INH ingestions, is not always available to emergency physicians.

Purpose of the Study:

  • To assess the availability of pyridoxine in U.S. hospitals.
  • To identify potential deficiencies in emergency preparedness for INH poisoning.

Main Methods:

  • Nationwide survey of hospital pharmacies and emergency departments (EDs) affiliated with pediatric emergency medicine (PEM) and emergency medicine (EM) residencies.
  • Questionnaires queried pyridoxine availability, quantity, location, and perceived importance.

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Main Results:

  • 81% of hospitals with PEM fellowships and 80% with EM residencies responded.
  • 33-50% of responding hospitals lacked the recommended 5-g pyridoxine aliquot.
  • Adequate pyridoxine stock was primarily stored in hospital pharmacies (80% PEM, 71% EM), not EDs.
  • In states with increased tuberculosis (TB) incidence, 33% lacked pyridoxine, and 39% did not consider it essential.

Conclusions:

  • A significant proportion of hospitals are unprepared to manage acute INH neurotoxicity.
  • Regional distribution centers for pyridoxine may be necessary, especially in high-incidence TB areas.
  • Improved availability and accessibility of pyridoxine in EDs are crucial for effective emergency care.