Journal List > Kosin Med J > v.29(1) > 1057034

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

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.

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Fig. 1.
Non-enhanced abdominal CT scan demonstrates lytic destructive change in Thoracic vertebral body.
kmj-29-63f1.tif
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.tif
Fig. 3.
Skin lesions of erythema and dry patches were observed on the buttock and abdomen.
kmj-29-63f3.tif
Fig. 4.
There is no gross abnormality in T2-weighted magnetic resonance imaging of brain.
kmj-29-63f4.tif
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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