Association of beta hydroxybutyric acidosis with isoniazid intoxication

Acute metabolic acidosis associated with accumulation of lactate has been previously reported in isoniazid (INH) intoxication. To our knowledge, association of INH toxicity with beta-hydroxybutyric acidosis has not been demonstrated previously. The present report documents the occurrence of beta-hydroxybutyric acidosis in patients with INH intoxication. The reason for the lack of previous reports of this association is not clear, although failure to measure plasma beta-hydroxybutyrate levels in previous studies is a likely possibility. Our patients received intravenous sodium bicarbonate, anticonvulsants and dialysis which resulted in complete reversal of metabolic acidosis and other manifestations of INH toxicity.