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Do not overlook acute isoniazid poisoning in children with status epilepticus
Hüseyin Caksen1, Dursun Odabas, Mehmet Erol
1Department of Pediatrics, Yüzüncü Yýl University, Faculty of Medicine, Van, Turkey. huseyincaksen@hotmail.com
Insights
Acute isoniazid poisoning can cause unexplained status epilepticus in children. Prompt pyridoxine treatment can effectively resolve seizures and improve outcomes in these critical cases.
Area of Science:
- Pediatric Neurology
- Clinical Toxicology
Background:
- Status epilepticus (SE) in children can be challenging to diagnose and manage.
- Idiopathic SE is a diagnosis of exclusion, requiring thorough investigation for underlying causes.
Observation:
- A previously healthy 2-year-old girl presented with severe generalized convulsive status epilepticus and metabolic acidosis.
- Initial treatment with standard anticonvulsants failed, but diazepam infusion achieved seizure control.
- The patient's parents reported accidental isoniazid overdose prior to admission.
Findings:
- Intravenous pyridoxine administration led to complete seizure resolution and clinical improvement.
- Liver function tests showed transient moderate elevation, normalizing by discharge.
- The patient remained seizure-free during follow-up after discontinuation of anticonvulsant therapy.
Implications:
- Acute isoniazid poisoning is a critical, treatable cause of status epilepticus in pediatric patients.
- Early consideration of toxicological etiologies, such as isoniazid overdose, is crucial for unexplained SE.
- Pyridoxine should be readily available for managing isoniazid-induced seizures.
Abstract:
A previously healthy 2-year-old girl was admitted with generalized convulsive status epilepticus. She was in a stupor and could respond only to painful stimuli. She also had severe metabolic acidosis. Although initial liver function tests were normal, they were found to be moderately high on the fifth day of admission; however, they dropped to their normal ranges on the twelfth day of admission. Initially, the patient was diagnosed as having idiopathic status epilepticus, and classic anticonvulsant agents, including diazepam, phenytoin, and then phenobarbital, were given. However, her seizures did not subside, and diazepam infusion was initiated. After initiation of diazepam infusion, the seizures were completely controlled. On the fourth day of admission, her parents said that she had accidentally received 20 tablets (a total dose of 2000 mg) of isoniazid just before admission to our hospital. Later, we injected 200 mg of pyridoxine intravenously. During follow-up, her general condition improved, and anticonvulsant agents were discontinued because an electroencephalogram was found to be norma. She was discharged from the hospital on the twelfth day of admission. At the fourth month of follow-up, she was seizure free. Because of this case, we would like to re-emphasize that acute isoniazid poisoning should also be considered in a child with unexplained status epilepticus.