Letter to Editor Hemodialysis for the Treatment of Isoniazid Intoxication

Authors : Ömer SALT, Mustafa Burak SAYHAN

Pages : 367-367

Doi:10.31362/patd.515282

View : 18 | Download : 5

Publication Date : 2019-09-30

Article Type : Other Papers

Abstract :Hemodialysis for the Treatment of Isoniazid Intoxication   To the Editor, We recently read with great interest the manuscript entitled “Secondary shoulder dislocation and fracture due to acute isoniazid intoxication”. The authors presented the treatment of a life-threatening condition, intractable seizures, metabolic acidosis with high anion gap related to Isoniazid insert ignore into journalissuearticles values(INH); intoxication insert ignore into journalissuearticles values(1);. High doses of INH are associated with metabolic acidosis, intractable convulsions, rhabdomyolysis, lactic acidosis, shock, decreased level of consciousness, coma, and even may cause death if not appropriately   treated insert ignore into journalissuearticles values(1);. Thus, its early and proper treatment is very important insert ignore into journalissuearticles values(2);.  In this case report, it was stated that the authors have performed a very successful treatment of isoniasid induced loss of consciousness and metabolic acidosis. It has been seen that the patient has ingested a dose of 1200 mg of INH before admission. It has been seen from the case that; the authors has treated the patient succesfully with midazolam and they have stopped the seizure in this way. It is well known that; pyridoxine is the one of the best treatment options in the treatment of INH intoxication. And this case is a perfect sample of this treatment method.             But, because of the little molecular weight and hydophilic structre INH has a low distribution volume insert ignore into journalissuearticles values(0.6L/kg); insert ignore into journalissuearticles values(2);. And INH reduces the levels of NAD that has a role in the transformation of lactate to piruvate. Lactate accumulates in the blood and acidosis and anion gap of the patient increases. Additionally INH decreases the activity of glutamic acid decarboxylase activity and due to the blockage of gamma amino butyric acid insert ignore into journalissuearticles values(GABA);, convulsion can develop easily insert ignore into journalissuearticles values(2,3);.  This situation may cause drug resistant convulsions and coma insert ignore into journalissuearticles values(1,4);. It could result with a life-threatening condition. Although in this patient, hemodialysis was not needed, hemodialysis is the alternative and effective treatment option in patients with refractory convulsions and comatose. Hemodialysis is not necessary in mild poisoning of INH but well effective in severe intoxication and it provides rapid clinical improvement in this situation. It removes INH which did not adhere to the activated charcoal and toxic metabolites of it from circulation insert ignore into journalissuearticles values(2,5);. It should be kept in mind as an effective treatment option in severe INH intoxication by Emergency physicians.
Keywords : Isoniazid Intoxication