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Toxicity, Isoniazid: Differential Diagnoses & Workup

Author: C Crawford Mechem, MD, MS, FACEP, Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department
Contributor Information and Disclosures

Updated: Mar 24, 2009

Differential Diagnoses

Metabolic Acidosis
Pediatrics, Status Epilepticus
Status Epilepticus

Workup

Laboratory Studies

  • No correlation exists between serum isoniazid (INH) levels and severity of acute intoxication. Laboratory studies generally are not helpful in diagnosis of acute INH toxicity but may identify complications.
    • Elevated anion gap metabolic acidosis (caused by lactic acid)
    • Hypokalemia
    • Hyperglycemia
    • Ketonemia
    • Transient elevation of liver enzyme levels
    • Leukocytosis
    • Positive DIC panel
    • Glycosuria
    • Ketonuria
    • Cerebrospinal fluid (CSF) pleocytosis
  • Laboratory abnormalities observed with INH therapy include the following:
    • Elevated liver enzyme levels - Patients with pretreatment aspartate aminotransferase (AST) levels above the upper limit of normal are predisposed to developing hepatotoxicity.
    • Granulocytopenia or agranulocytosis
    • Eosinophilia
    • Thrombocytopenia
    • Anemia

More on Toxicity, Isoniazid

Overview: Toxicity, Isoniazid
Differential Diagnoses & Workup: Toxicity, Isoniazid
Treatment & Medication: Toxicity, Isoniazid
Follow-up: Toxicity, Isoniazid
References
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References

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Further Reading

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Keywords

isoniazid toxicity, isoniazid poisoning, isoniazid exposure, treatment, symptoms, causes, isonicotinic acid hydrazide, INH, antituberculous medications, treatment of tuberculosis, prophylaxis of tuberculosis, isoniazid overdose, INH overdose, INH toxicity, INH poisoning, isoniazid ingestion, INH ingestion, tuberculosis treatment

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Contributor Information and Disclosures

Author

C Crawford Mechem, MD, MS, FACEP, Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department
C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School
David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

John G Benitez, MD, MPH, FACMT, FACPM, FAAEM, Associate Professor, Department of Medicine, Clinical Pharmacology Division, Vanderbilt University; Managing Director, Tennessee Poison Center
John G Benitez, MD, MPH, FACMT, FACPM, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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