Articole semnate de acelasi autor in Revista Romana de Pediatrie:

INTOXICATIA ACUTA CU TUBERCULOSTATICE: RECUNOASTERE SI TRATAMENT

Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Dora Andreea Boghitoiu and Coriolan Emil Ulmeanu

REZUMAT

Introducere. Deşi frecvenţa intoxicaţiilor cu izoniazidă nu este una foarte mare, reprezintă condiţii ameninţătoare de viaţă care necesită recunoaştere şi instituire promptă a tratamentului.
Material şi metodă. Autorii prezintă cazul unei paciente în vârstă de 15 ani care se internează în clinica noastră prin transfer dintr-o altă unitate medicală pentru convulsii tonico-clinice generalizate, urmate de vărsături şi comă. Pacienta este primită în Unitatea Primiri Urgenţe a spitalului nostru în comă, Glasgow 8, intubată orotraheal. Nu răspunde la stimuli verbali, dar răspunde prin agitaţie marcată la stimuli dureroşi profunzi. Are sondă nazogastrică pe care se exteriorizează lichid portocaliu, iar pe sonda urinară – urini de culoare portocalie. Pupilele sunt egale, intermediare, reactive. Reflexe osteotendinoase sunt prezente bilateral. Nu are semne de iritaţie meningeană şi nici semne neurologice de focar. Din istoricul medical al pacientei, obţinut de la mamă, am reţi nut că pacienta se afla de 4 luni în tratament cu medicamente tuberculostatice (izoniazidă, rifampicină şi vita mina B6). Pacienta îşi administra singură medicamentele.
Rezultate. Pe baza manifestărilor clinice: convulsii tonico-clonice generalizate, vărsături incoercibile şi comă, a aspectului roşu-portocaliu al lichidului gastric şi al urinii la mai mult de 6 ore de la debut, a istoricului medical al pacientei şi al analizelor paraclinice care decelează acidoză metabolică se ridică suspiciunea de intoxicaţie acută cu tuberculostatice. S-a început administrarea de tratament antidotic cu vitamina B6 cu evoluţie favorabilă.
Concluzii. Intoxicaţia acută cu izoniazidă trebuie suspectată la orice pacient care prezintă triada clasică: convulsii refractare, acidoză metabolică severă şi comă, iar tratamentul antidotic cu piridoxină trebuie sa fie disponibil în orice serviciu de urgenţe.

Cuvinte cheie: izoniazidă, acidoză metabolică, convulsii generalizate, intoxicaţie, vitamina B6

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Dora Andreea Boghitoiu

TUBERCULOSTATICS ACUTE POISONING: DIAGNOSTIC AND TREATMENT

ISSN 1454-0398 | e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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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Dora Andreea Boghitoiu