Asnis D S, Bhat J G, Melchert A F
Department of Internal Medicine, Flushing Hospital Medical Center, NY 11355.
Ann Pharmacother. 1993 Apr;27(4):444-6. doi: 10.1177/106002809302700410.
To report a case of reversible seizures and mental status changes in a dialysis patient given preventive isoniazid therapy.
A 66-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) was given isoniazid prophylaxis following a purified protein derivative (PPD) reaction greater than 20 mm in duration. Oral administration of isoniazid 300 mg/d was started and four days later she was admitted to the hospital for confusion, lethargy, and focal seizures that began 24 hours after initiation of therapy. All medications were discontinued with the exception of oral pyridoxine 50 mg/d. Dialysis was withheld to determine if the seizures were medication induced rather than uremia related. Seizures and mental status changes were reversed with pyridoxine. Dialysis was restarted after the symptoms resolved.
Preventive therapy against tuberculosis with isoniazid should be stressed throughout the medical community. Isoniazid has adverse effects including hepatitis and peripheral neuropathy (common) and convulsions (rare). Our experience suggests that additional supplementation with pyridoxine 50 mg/d should be given routinely to prevent adverse reactions in uremic patients.
报告一例接受预防性异烟肼治疗的透析患者出现可逆性癫痫发作和精神状态改变的病例。
一名66岁持续非卧床腹膜透析（CAPD）患者，在纯化蛋白衍生物（PPD）反应持续时间大于20mm后接受异烟肼预防治疗。开始口服异烟肼300mg/d，四天后因在治疗开始24小时后出现意识模糊、嗜睡和局灶性癫痫发作而入院。除口服50mg/d吡哆醇外，停用所有药物。暂停透析以确定癫痫发作是药物引起而非与尿毒症相关。吡哆醇使癫痫发作和精神状态改变得到逆转。症状缓解后重新开始透析。
整个医学界应重视用异烟肼进行结核病的预防性治疗。异烟肼有不良反应，包括肝炎和周围神经病变（常见）以及惊厥（罕见）。我们的经验表明，应常规额外补充50mg/d吡哆醇以预防尿毒症患者出现不良反应。
