Isoniazid overdose treated with high-dose pyridoxine

Area of Science:

• Toxicology
• Pharmacology
• Emergency Medicine

Background:

• Isoniazid is a first-line antitubercular drug.
• Massive isoniazid ingestion can lead to severe toxicity, including seizures and metabolic acidosis.
• Pyridoxine (vitamin B6) has shown prophylactic effects against isoniazid-induced seizures.

Observation:

• Three cases of massive isoniazid ingestion were reported.
• Patients presented with seizures and metabolic acidosis.
• Treatment involved intravenous administration of pyridoxine.

Findings:

• A dose of one gram of pyridoxine was administered intravenously for each gram of isoniazid ingested.
• This treatment successfully resolved the seizures and acidosis in all three patients.
• Pyridoxine administration was effective in managing acute isoniazid toxicity.

Implications:

• Intravenous pyridoxine is a potentially life-saving antidote for severe isoniazid overdose.
• This case series supports the use of pyridoxine in managing isoniazid-induced seizures and acidosis.
• Further research should explore optimal dosing and efficacy of pyridoxine in isoniazid poisoning.