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Isoniazid poisoning: pharmacokinetics and effect of hemodialysis in a massive ingestion

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dc.contributor.authorSkinner, K.
dc.contributor.authorSaiao, A.
dc.contributor.authorMostafa, A.
dc.contributor.authorSoderstrom, J.
dc.contributor.authorMedley, G.
dc.contributor.authorRoberts, M.S.
dc.contributor.authorIsbister, G.K.
dc.date.issued2015
dc.description.abstractIsoniazid is a rare overdose that causes seizures and there is limited evidence to guide treatment. We report a 20-year-old female migrant who presented with recurrent seizures after ingesting 25g of isoniazid. She was treated with activated charcoal, repeated doses of midazolam for the seizures, and given multiple doses of pyridoxine (14mg), limited by availability. She was admitted to intensive care, and 5.5 hours post-ingestion, she was commenced on continuous veno-venous hemodiafiltration (CVVHDF). She was extubated after 24 hours and CVVHDF was ceased 6 hours later (30 hours post-overdose). Her renal function remained normal and her initial lactate was the highest at 2.3. She made a full recovery. Five plasma samples were collected before, during, and after CVVHDF, and isoniazid was quantified with liquid chromatography-tandem mass spectrometry. A pharmacokinetic analysis of time-isoniazid concentration data was fitted to a two-compartment model with first-order input (with fixed ka) with the effect of CVVHDF modeled as a time-dependent covariate. This suggested that there was initially good clearance with CVVHDF (4 times endogenous clearance), which rapidly declined within hours.
dc.identifier.citationHemodialysis International, 2015; 19(4):37-40
dc.identifier.doi10.1111/hdi.12293
dc.identifier.issn1492-7535
dc.identifier.issn1542-4758
dc.identifier.urihttps://hdl.handle.net/11541.2/116889
dc.language.isoen
dc.publisherWiley-Blackwell
dc.relation.fundingNHMRC 1055176
dc.relation.fundingNHMRC 1061041 Research Fellowship
dc.relation.fundingNHMRC 1002611 Research Fellowship
dc.rightsCopyright 2015 International Society for Hemodialysis
dc.source.urihttps://doi.org/10.1111/hdi.12293
dc.subjectisoniazid
dc.subjectpoisoning
dc.subjectoverdose
dc.subjectpharmacokinetics
dc.subjecthemodialysis
dc.subjectseizure
dc.titleIsoniazid poisoning: pharmacokinetics and effect of hemodialysis in a massive ingestion
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916007611101831

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