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Isoniazid overdose: recognition and management

J A Romero¹, F J Kuczler

¹Jacksonville Healthcare Group, Florida, USA.

American Family Physician

|March 10, 1998

Summary

Isoniazid overdose can cause severe seizures, metabolic acidosis, and death. Prompt treatment with pyridoxine (vitamin B6) is crucial for managing isoniazid toxicity and preventing fatal outcomes.

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Area of Science:

Toxicology
Pharmacology
Internal Medicine

Background:

Isoniazid is a vital medication for tuberculosis control.
Physicians must recognize the severe toxicity associated with isoniazid overdose.

Observation:

Acute isoniazid ingestion, even at 1.5 g in adults, can lead to toxicity.
Symptoms include nausea, vomiting, seizures, metabolic acidosis, coma, and potentially death.
Seizures are often refractory to standard anticonvulsant treatments.

Findings:

Isoniazid doses exceeding 30 mg/kg can induce seizures.
Lethal isoniazid ingestion ranges from 80 to 150 mg/kg.
Pyridoxine (vitamin B6), administered in equivalent doses to the ingested isoniazid, effectively resolves seizures and corrects metabolic acidosis.

Implications:

Isoniazid toxicity should be suspected in patients with unexplained refractory seizures and metabolic acidosis.
Early recognition and administration of pyridoxine are critical for patient survival.
Understanding isoniazid's toxicological profile is essential for safe tuberculosis treatment protocols.

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