Dora Andreea Boghitoiu and Coriolan Emil Ulmeanu

ABSTRACT

Introduction. Although the frequency of isoniazid poisoning is not very high, there are life threatening conditions which require a swift diagnosis and treatment.
Material and method. We present the case of a female patient, aged 15 admitted in our clinic, by means of transfer, from another medical unit, due to tonic-clonic generalized seizures, followed by emesis and coma. The patient arrived at the Emergency Admissions Unit of our hospital, in coma, Glasgow 8, orotracheally intubated. She did not respond to verbal stimuli, but she did respond to deep, painful stimuli with marked agitation. The patient has a nasogastric tube, on which an orange liquid is visible on the outside and on the urinary catheter – orange coloured urine. From the patient’s medical history, which was obtained from the patient’s mother, we noticed that the patient had been, for the past 4 months, under treatment with tuberculostatic drugs (Isoniazid, Rifampicin and vitamin B6). The patient administered the medication herself.
Results. Based on clinical manifestations, i.e. tonic-clonic generalized seizures, incoercible emesis and coma, reddish-orange colour of the gastric fluid and urine, at over 6 hours after the onset, on the patient’s medical historyand based on laboratory results which revealed metabolic acidosis the suspicion of acute tuberculostatic poisoning arose. We started antidotal therapy with vitamin B6 with favourable clinical evolution.
Conclusion. Acute isoniazid poisoning must be suspected in the case of any patient who presents the classic triad: refractory seizures, severe metabolic acidosis and coma and the treatment with the specific antidotepyridoxine, must be available at any emergency unit.

Keywords: isoniazid, metabolic acidosis, generalized seizures, poisoning, vitamin B6

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