Asiimwe Edgar, Koh Michelle, Patel Rajan
Internal Medicine, University of California Los Angeles, Los Angeles, USA.
Internal Medicine, Olive View - UCLA (University of California Los Angeles) Medical Center, Los Angeles, USA.
Cureus. 2022 Mar 16;14(3):e23218. doi: 10.7759/cureus.23218. eCollection 2022 Mar.
A 68-year-old male with a history of end-stage renal disease and latent tuberculosis on isoniazid (INH), and no psychiatric history presented with a five-day history of anorexia, fatigue, and nausea. Physical exam in the emergency department was notable for somnolence, right upper extremity tremor, and diffuse abdominal pain. Initial workup revealed an anion gap metabolic acidosis with elevated lactate, prompting admission to the general ward for empiric IV antibiotics for suspected bacteremia from his permacath. Within a few hours of admission, he became increasingly encephalopathic and had two episodes of copious hematemesis. Repeat studies revealed a cholestatic pattern of liver injury and new-onset coagulopathy. With an overall clinical picture consistent with fulminant hepatic failure, our pharmacy team initiated a comprehensive pill count of all his medications, which established that he had been inadvertently taking up to six times the recommended dose of INH. With INH discontinuation and supportive therapy, he improved and was discharged on hospital day eight. Our experience provides lessons in the timely recognition and management of this rarely reported toxidrome in the United States.
一名68岁男性，有终末期肾病病史，正在服用异烟肼（INH）治疗潜伏性结核，无精神病史，出现了为期五天的厌食、乏力和恶心症状。急诊科的体格检查发现嗜睡、右上肢震颤和弥漫性腹痛。初步检查显示阴离子间隙代谢性酸中毒伴乳酸升高，遂因怀疑经皮中心静脉导管引起菌血症而入住普通病房接受经验性静脉抗生素治疗。入院后数小时内，他的脑病症状逐渐加重，并出现两次大量呕血。复查发现肝损伤呈胆汁淤积型，且出现新发凝血功能障碍。鉴于整体临床表现符合暴发性肝衰竭，我们的药学团队对他所有的药物进行了全面清点，结果发现他无意中服用的INH剂量高达推荐剂量的六倍。停用INH并给予支持治疗后，他的病情有所改善，并于住院第八天出院。我们的经验为及时识别和处理美国这种罕见报道的中毒综合征提供了经验教训。
