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Case Report
A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman
Young Shin Shin1, Eun Hee Sim1, Chang Woo Yeo1, Jin Doo Kang1, Ji Yeon Kim1, Seon Ja Park2
Kosin Medical Journal 2014;29(1):63-68.
DOI: https://doi.org/10.7180/kmj.2014.29.1.63
Published online: December 17, 2014

1Department of Internal Medicine, Dae-Dong Hospital, Busan, Korea

2Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Ji Yeon Kim, Deparment of Internal Medicine, Dae-Dong Hospital, 187 Chungyel-daero, Dongrae-gu, Busan, 607-711, Korea TEL: +82-10-9323-9669 FAX: +82-51-553-7575 E-mail: bbuss36@naver.com
• Received: March 7, 2013   • Revised: May 26, 2013   • Accepted: July 10, 2013

Copyright © 2014 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Isoniazid is one of the most commonly used antituberculosis drug. Acute into xication is characterized by repetitious convulsions, high anion gap metabolic a cidosis and coma. The basis of theraphy consists of parental pyridoxine admi nistration in a dose equivalent to that of isoniazid ingested. Here we present a case of seizure and metabolic acidosis due to only renal adjustment dosage of Isoniazid in an elderly woman.
  • Keywords: Isoniazid; Metabolic acidosis; Pyridoxine; Seizure
Fig. 1.
Non-enhanced abdominal CT scan demonstrates lytic destructive change in Thoracic vertebral body.
kmj-29-63f1.jpg
Fig. 2.
T2-weighted sagittal MRI of spine demonstrates destruction of T10, T 11, T12 bodies due to spinal tuberculosis and secondary to abscess formation.
kmj-29-63f2.jpg
Fig. 3.
Skin lesions of erythema and dry patches were observed on the buttock and abdomen.
kmj-29-63f3.jpg
Fig. 4.
There is no gross abnormality in T2-weighted magnetic resonance imaging of brain.
kmj-29-63f4.jpg
Table 1.
Serial of arterial blood gas analysis
  HD#10∗ HD#10† HD#10‡ HD#10§ HD#11 (2) HD#12 (3) HD#13 (4) HD#14 (5)
pH 7.261 7.064 7.187 7.210 7.266 7.327 7.411 7.445
PaCO2 (mm mHg) 21 52.3 56.7 50.6 47.4 45 42.2 36.6
PaO2 (mmH Hg) 95.5 116.1 68.1 89.5 98.5 95.5 111.1 87.3
HCO3-(mmo ol/L) 14.1 14.9 18.9 20.0 21.1 23.3 26.2 24.6
Base exces s -13.1 -15.2 -9.5 -8.1 -5.9 -2.9 1.6 0.5

HD: hospital day. ∗At the time of seizure onset

†After supplying O2 3L/min via nasal prong

‡After bicarbonate administration, with symptoms of cyanosis & mental change

§After applying non-invasive ventilator

Number of days after administrating pyridoxine.

Table 2.
Comparison of laboratory examination findings before and after administrating antituberculosis agents
  HD#1 (before administrating) HD#10 (after administrating)
Hemoglobin (g/dl, 12-16) 8.2 8.2
WBC(k/ul, 4-10) 10.06 6,170
neutrophil (%) 74.9 63.4
lymphocyte (%) 14.6 13.8
eosinophil (%) 4.7 12.6
BUN (mg/dl, 9-23) 34.5 32.2
Creatinine (mg/dl, 0.5-1.2) 1.6 1.4
Na+ (mEq/L, 132-146) 131 135
K+ (mEq/L, 3.5-5.5) 3.7 5.1
AST/ALT (IU/L, 5-45) 29/13 25/11
Cr clearance (ml/min) 31.14 27.39
  • 1. Kook DH, Cho SY, Lee KY, Lee IG, Lee JS. A case of acute isoniazid into xication in childhood. J Korean Child Neurol Soc 2006;14:358–62.
  • 2. Topcu I, Yentur EA, Kefi A, Ekici NZ, Sakarya M. Seizures, metabolic acidosi s and coma resulting from acute isoniazid intoxication. Anaesth Intensive Care 2005;33:518–20.ArticlePubMed
  • 3. Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rif ampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J 1996;9:2026–30.ArticlePubMed
  • 4. Romero JA, Kuczler FJ Jr. Isoniazid overdose: recognition and management. Am Fam Physician 1998;57:749–52.PubMed
  • 5. Hankins DG, Saxena K, Faville RJ Jr, Warren BJ. Profound acidosis caused by iso niazid ingestion. Am J Emerg Med 1987;5:165–6.ArticlePubMed
  • 6. Weber WW, Hein DW. Clinical pharmacokinetics of isoniazid. Clin Pharmacokinet 1979;4:401–22.ArticlePubMed
  • 7. Holtz P, Palm D. Pharmacological aspects of vitamin B6. Pharmacol Rev 1964;16:113–78.PubMed
  • 8. Fukino K, Sasaki Y, Hirai S, Nakamura T, Hashimoto M, Yamagishi F, et al. Effects of N-acetyltransferase 2 (NAT2), CYP2E1 and Glutathione-S-transferase (GST) genotypes on the serum concentrations of isoniazid and metabolites in tube rculosis patients. J Toxicol Sci 2008;33:187–95.ArticlePubMed
  • 9. Kang TS, Jin SK, Lee JE, Woo SW, Roh J. Comparison of genetic polymorphi sms of the NAT2 gene between Korean and four other ethnic groups. J Clin Pha rm Ther 2009;34:709–18.Article
  • 10. Holdiness MR. Neurological manifestations and toxicities of the antituberculosis dru gs. A review. Med Toxicol 1987;2:33–51.ArticlePubMed
  • 11. Wason S, Lacouture PG, Lovejoy FH Jr. Single high-dose pyridoxine treat ment for isoniazid overdose. JAMA 1981;246:1102–4.ArticlePubMed
  • 12. Tai WP, Yue H, Hu PJ. Coma caused by isoniazid poisoning in a patient treated with pyridoxine and hemodialysis. Adv Ther. 2008;25:1085–8.ArticlePubMed

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        A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman
        Kosin Med J. 2014;29(1):63-68.   Published online December 17, 2014
        DOI: https://doi.org/10.7180/kmj.2014.29.1.63
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      A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman
      Image Image Image Image
      Fig. 1. Non-enhanced abdominal CT scan demonstrates lytic destructive change in Thoracic vertebral body.
      Fig. 2. T2-weighted sagittal MRI of spine demonstrates destruction of T10, T 11, T12 bodies due to spinal tuberculosis and secondary to abscess formation.
      Fig. 3. Skin lesions of erythema and dry patches were observed on the buttock and abdomen.
      Fig. 4. There is no gross abnormality in T2-weighted magnetic resonance imaging of brain.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Fig. 4.

      A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman

      Serial of arterial blood gas analysis

        HD#10∗ HD#10† HD#10‡ HD#10§ HD#11 (2) HD#12 (3) HD#13 (4) HD#14 (5)
      pH 7.261 7.064 7.187 7.210 7.266 7.327 7.411 7.445
      PaCO2 (mm mHg) 21 52.3 56.7 50.6 47.4 45 42.2 36.6
      PaO2 (mmH Hg) 95.5 116.1 68.1 89.5 98.5 95.5 111.1 87.3
      HCO3-(mmo ol/L) 14.1 14.9 18.9 20.0 21.1 23.3 26.2 24.6
      Base exces s -13.1 -15.2 -9.5 -8.1 -5.9 -2.9 1.6 0.5

      Comparison of laboratory examination findings before and after administrating antituberculosis agents

        HD#1 (before administrating) HD#10 (after administrating)
      Hemoglobin (g/dl, 12-16) 8.2 8.2
      WBC(k/ul, 4-10) 10.06 6,170
      neutrophil (%) 74.9 63.4
      lymphocyte (%) 14.6 13.8
      eosinophil (%) 4.7 12.6
      BUN (mg/dl, 9-23) 34.5 32.2
      Creatinine (mg/dl, 0.5-1.2) 1.6 1.4
      Na+ (mEq/L, 132-146) 131 135
      K+ (mEq/L, 3.5-5.5) 3.7 5.1
      AST/ALT (IU/L, 5-45) 29/13 25/11
      Cr clearance (ml/min) 31.14 27.39
      Table 1. Serial of arterial blood gas analysis

      HD: hospital day. ∗At the time of seizure onset

      After supplying O2 3L/min via nasal prong

      After bicarbonate administration, with symptoms of cyanosis & mental change

      After applying non-invasive ventilator

      Number of days after administrating pyridoxine.

      Table 2. Comparison of laboratory examination findings before and after administrating antituberculosis agents

      Table 1.

      Table 2.

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