Chang Y D, Yang C C, Lin T J, Ger J, Deng J F
Primary Care Medical Department, Chang-Gung Memorial Hospital, Tao-Yuan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1996 Feb;57(2):152-6.
Since its introduction in 1952, isoniazid has remained one of the drugs of choice in the treatment and prophylaxis of tuberculosis. In populations with a high prevalence rate of tuberculosis or suicide rate, acute ingestion of isoniazid has occasionally been reported. Acute intoxication by isoniazid is known to cause symptoms of seizures, metabolic acidosis, coma, and even death. These clinical symptoms, however, are not well recognized by physicians in Taiwan, even though the prevalence rate of tuberculosis is relatively high here. This report concerns the case of a 25-year-old female with a past history of tuberculosis who presented with the symptoms of refractory seizures, metabolic acidosis and deep coma after intentional ingestion of some unknown drug. Although implicating agents were not recognized initially, she was successfully revived with basic resuscitation, anticonvulsants and correction of metabolic acidosis. A review of her history revealed that her ingestion of five grams of isoniazid in this case was responsible for the entire clinical spectrum. Given easy access to isoniazid in Taiwan, a diagnosis of isoniazid poisoning should always be considered in patients who present with the classical symptoms of refractory seizures, metabolic acidosis and coma.
自1952年引入以来，异烟肼一直是治疗和预防结核病的首选药物之一。在结核病患病率或自杀率较高的人群中，偶尔有急性摄入异烟肼的报道。已知异烟肼急性中毒会导致癫痫发作、代谢性酸中毒、昏迷甚至死亡。然而，尽管台湾地区的结核病患病率相对较高，但当地医生对这些临床症状并未充分认识。本报告涉及一名25岁有结核病病史的女性，她在故意摄入某种不明药物后出现难治性癫痫发作、代谢性酸中毒和深度昏迷症状。尽管最初未识别出致病药物，但通过基本复苏、抗惊厥药物治疗和代谢性酸中毒的纠正，她成功苏醒。回顾她的病史发现，此次摄入5克异烟肼导致了整个临床症状。鉴于在台湾地区异烟肼容易获取，对于出现难治性癫痫发作、代谢性酸中毒和昏迷等典型症状的患者，应始终考虑异烟肼中毒的诊断。
