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

Young Shin Shin; Eun Hee Sim; Chang Woo Yeo; Jin Doo Kang; Ji Yeon Kim; Seon Ja Park

doi:10.7180/kmj.2014.29.1.63

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Shin, Sim, Yeo, Kang, Kim, and Park: A Case of Seizure and Metabolic Acidosis Due to Renal Adjustment Dosage of Isoniazid in an Elderly Woman

Case Report

Kosin Medical Journal 2014;29(1):63-68.

Published online: 17 December 2014

DOI: https://doi.org/10.7180/kmj.2014.29.1.63

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

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 7 March 2013 Revised 26 May 2013 Accepted 10 July 2013

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.

Abstract

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

REFERENCES

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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.

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

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