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Treatment of a potentially lethal dose isoniazid ingestion
J P Orlowski1, E P Paganini, C E Pippenger
1Pediatric Unit, Cleveland Clinic Foundation, Ohio 44106.
Abstract:
A seven-year-old boy ingested 3,000 mg (125 mg/kg) of isoniazid. Initial blood levels of isoniazid were 250 micrograms/mL approximately six hours after ingestion. Despite IV treatment in the emergency department with 3,000 mg pyridoxine and a repeat of the same antidote one hour later in the intensive care unit, the high isoniazid blood levels and persistent metabolic acidosis and coma prompted a decision to increase drug clearance by hemodialysis. Clearance data confirmed the effectiveness of hemodialysis in removing the poison, and the clinical response was dramatic.
Insights
A child survived a severe isoniazid overdose with prompt treatment. Hemodialysis effectively cleared the drug, reversing coma and metabolic acidosis for a dramatic recovery.
Area of Science:
- Toxicology
- Pediatric Medicine
- Emergency Medicine
Background:
- Isoniazid is a first-line medication for tuberculosis treatment.
- Isoniazid overdose can lead to severe neurological and metabolic complications.
Observation:
- A 7-year-old boy ingested 3,000 mg of isoniazid, resulting in high blood levels (250 µg/mL at 6 hours).
- The patient presented with coma and persistent metabolic acidosis despite initial treatment with pyridoxine.
Findings:
- Hemodialysis was initiated to enhance isoniazid clearance due to persistent toxicity.
- Clearance data demonstrated hemodialysis's effectiveness in removing isoniazid.
- The patient showed a dramatic clinical improvement following hemodialysis.
Implications:
- Hemodialysis is a viable option for managing severe isoniazid toxicity when conventional treatments are insufficient.
- This case highlights the importance of considering enhanced drug removal techniques in critical poisoning scenarios.
- Early recognition and aggressive management are crucial for favorable outcomes in isoniazid overdose.