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Toxicity, Isoniazid: Follow-up

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

Follow-up

Further Inpatient Care

  • Admit patients with refractory seizures or severe acidosis to an intensive care unit.

Transfer

  • Transfer patients after stabilization of vital signs if ICU facilities or a medical toxicologist is warranted but unavailable.

Deterrence/Prevention

  • Routine monitoring of aspartate aminotransferase (AST) levels among patients undergoing isoniazid (INH) prophylaxis may detect early cases of hepatotoxicity.

Complications

Complications of isoniazid toxicity include the following:

  • Aspiration
  • Pneumonia
  • Hypotension
  • Cardiorespiratory arrest

Prognosis

  • The prognosis is largely dependent on early identification and correction of complications.
  • Advanced age, underlying seizure disorder, severe metabolic acidosis, and decreased renal function are associated with a poor prognosis.
  • Serum eosinophilia may be associated with a favorable outcome in patients with INH-induced hepatotoxicity.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider isoniazid toxicity in both adult and pediatric patients presenting with new-onset, recurrent, or refractory seizures
  • Inadequate supply of pyridoxine on-hand. Management of a single severely intoxicated patient may require 20 g of pyridoxine. Therefore, this amount should be readily available if tuberculosis is common among the patient population. Because pyridoxine has few other emergent indications, individual hospitals may have insufficient quantities to manage critically intoxicated patients. Therefore, establishment of a network of resources from which hospitals can obtain adequate quantities rapidly should be considered.
  • Failure to treat seizures with traditional medications, including benzodiazepines and barbiturates, in addition to pyridoxine
 


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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