Isoniazid poisoning: signs, consequences, emergency care

Isoniazid is an antibacterial agent that is used to treat tuberculosis. This is a potent remedy, which is in a separate classification in the pharmaceutical directory. It is effective against mycobacteria tuberculosis, which can not be killed by any other means. It has a bacteriostatic effect on microorganisms, but at the same time it has a strong toxic effect on the body. Isoniazid poisoning is a fairly common and very dangerous phenomenon. Poisoning is observed both when the dosage is exceeded, and when the drug is taken for a long time. Often, poisoning results in death, as irreversible damage to the heart and breathing develops, severe convulsions and spasms appear. Therefore, it is necessary to take isoniazid strictly according to the scheme that the doctor appointed.

[1], [2], [3], [4]

Epidemiology

Absorbed by about 97%, with an antibacterial effect of 90% for mycobacteria, which are the causative agents of the disease. Already after 6 hours in blood plasma concentration is 50%, and after 24 hours the drug in the blood is not determined. Intoxication is observed in approximately 57% of patients. In chronic poisoning, signs of hepatitis are diagnosed in 1% of patients, while the death rate from hepatic pathologies is 1.001%.

[5], [6], [7], [8], [9]

Causes of the isoniazid poisoning

Isoniazid to poison very easily, because it is a strong toxic agent, and is also easily absorbed through the walls of the stomach and intestines. You can get poisoned one day after taking the medicine. Also, the reason may be a lack in the body of pyridoxine, which is a natural neutralizer of this drug and a inhibitory mediator of the central nervous system.

[10], [11], [12], [13], [14], [15]

Risk factors

Absolutely all patients who take this drug are at risk of poisoning. But the greatest probability of poisoning in those who take the drug for a long time, as well as in children and the elderly. Especially high risk of poisoning in people who have a violation of the kidneys and liver, because it is these organs that neutralize and remove toxins. Also, people who have a deficiency of pyridoxine in the body are at increased risk.

[16], [17], [18], [19], [20]

Pathogenesis

At the heart of the pathogenesis is a violation of the biochemical cycle, in which the action of the enzyme, which is necessary for the synthesis of acids in the cell wall of mycobacteria, is inhibited. These substances inhibit the activity of the cell of the microorganism, or completely kill it. At the same time, toxic products of the microorganism's vital activity are formed, which together with the high doxa of the active substance of the preparation form a toxin, which destroys the cells of the body. If excretion is impaired, acute poisoning develops. With prolonged accumulation of toxins inside cells and tissues, poisoning develops gradually, chronically.

Toxic effect is also achieved by a high level of digestion by the body. The drug is absorbed within 2 hours after admission, it appears in the blood serum, spreads through the body and penetrates into all cells and tissues, exerting a toxic effect. It is distributed at the rate of approximately 0.6 liters per kilogram of body weight. Decay products are isonicotinic acid and acetylhydrosine, which also have a toxic effect on the body in large doses.

The toxic effect of these substances is based on a deficiency of pyridoxine, which is caused by various methods. Normally, pyridoxine neutralizes the action of poisonous substances, promotes their removal from the body.

[21], [22], [23], [24], [25]

Symptoms of the isoniazid poisoning

Two forms of poisoning are known: acute and chronic. These forms manifest themselves in different ways.

In acute form there are strong convulsions, seizures of epilepsy. The first help, which usually happens with epilepsy, has no effect. The situation is aggravated, the coma develops. In the early stages, a person can tear, coordination of movements is disrupted. Sharply joins the strong dizziness, often leading to loss of consciousness, as well as tachycardia. However, these symptoms do not always have a place to be. Quite often, poisoning manifests itself immediately by a sharp loss of consciousness and an epileptic seizure. End this condition can be a severe coma, the duration of which is from 24 to 36 hours. The coma continues even after the seizure is over and acidosis has passed. Also, signs of acute poisoning can be arterial hypotension, hyperthermia, hyperglycemia and ketonuria, which can have serious consequences for biochemical metabolism.

Chronic poisoning develops as a result of long-term use of the drug. This causes a large number of pathologies. The simplest form is vomiting and dyspeptic disorders. The most unfavorable variant is necrosis of hepatocytes of the liver, in which the liver not only ceases to fulfill its function, but gradually dies. The biochemistry of the body is disrupted, in particular, the level of aminotransferases sharply increases. The danger of this form is that it can continue to be asymptomatic for a long time, and will only be felt when the severe lesions of internal organs develop.

[26]

First signs

At best, with acute poisoning, there may be signs such as vomiting, dizziness, dyspnea and heart rhythm. In the worst case - the disease develops sharply, spontaneously, and is accompanied by loss of consciousness, seizures, a violation of the heart. With chronic poisoning, the danger is that no early signs are observed. The disease manifests itself when hepatocytes are damaged and irreversible processes develop in the liver.

[27], [28]

Stages

Poisoning has two stages. First, internal injuries develop which are asymptomatic and do not manifest themselves in any way. This is a latent stage. In acute forms, the biochemical cycle is disrupted, mainly at the cellular and tissue levels.

The second stage is obvious, in which poisoning is manifested by clinical symptoms. When the acute form develops seizures or convulsions, with chronic - liver damage.

The third stage depends on the measures taken. If timely and correct first aid and necessary treatment is carried out, recovery and recovery are possible. If such measures were not taken, a coma develops, then - a lethal outcome.

The dose for isoniazid poisoning

The lethal dose for oral administration is 20 mg / kg of active ingredient and more.

[29]

Human isoniazid poisoning

Isoniazid provokes poisoning when the dosage is exceeded, as well as with prolonged use of the drug. Significantly increases the risk of poisoning in violation of kidney and liver, as well as a low level of pyridoxine in the body. The danger is that the poisoning can result in a fatal outcome (cardiac arrest, prolonged coma, convulsive syndrome).

Isoniazid poisoning of cats

Most often, cat poisoning with isoniazid is an accident. A cat can inadvertently eat a medicine because of its curiosity. Poisoning for a cat is deadly, you need to take urgent measures to save lives. To do this, you need to deliver the affected animal as quickly as possible to the vet. At home, you can not help, so you need to get to the doctor as quickly as possible. The doctor will determine the cause, if you know for sure that the cat is poisoned with isoniazid, you need to report this to the veterinarian, in order to speed up the provision of care. This will help save time and do not spend it on diagnostics.

The doctor knows the antidote to this remedy and can quickly remove the body from a toxic shock. First of all, vomiting is caused, which will prevent further absorption of the substance and stop further poisoning. Vomiting in cats is caused by a solution of 3% hydrogen peroxide, which is poured into the mouth at the rate of 5 ml per 1.5 kg of body weight. You need to give three times, with an interval of 10 minutes.

Further, an antidote, pyridoxine, is used in the form of injections or droppers. If after a cat has eaten isoniazid, it took more than two hours, it is advisable immediately to proceed with the introduction of the antidote, since the drug has already entered the circulatory system and in its intestine is almost absent, respectively, vomiting does not help. It is necessary to give a lot of water and not to drink for 1-2 days.

Cats develop lethargy, apathy, lack of energy. The cat is constantly salivating and the pupils are dilated. Orientation in space is broken, do not stand on your feet. If the doctor was too late and nothing is possible, irreversible disturbances in vital organs have gone, it is better to immediately put the animal to sleep, since death from isoniazid is painful. The animal has vomiting with blood, intense excitement, severe pain, foam at the mouth. The animal can not be controlled, frightened, not oriented in space. After 2-3 days of such torture, the animal stops moving, the kidneys and liver fail. There is incontinence of urine and feces. The danger is that with a strong and young heart, life can be sustained for a long time. In this case, the animal experiences painful pain. On the surface there are wounds, ulcers, worms are gradually planted, parasitize on a living cat. Eventually the animal will die.

Isoniazid poisoning in dogs

Isoniazid poisoning in dogs develops as a result of an accident, with accidental ingestion of a drug. Sometimes it is deliberate - there are frequent cases when the so-called "dog-hunters" deliberately poison dogs using isoniazid.

It can only help timely introduction of the antidote. For dogs, the antidote is pyridoxine, which neutralizes the action of the poison. To provide first aid, you must immediately go to a veterinary clinic, because often animals are brought, when nothing can be helped. From the moment of getting the substance into the blood there is exactly an hour to save the animal. Otherwise, irreversible damage to the liver, kidneys and other vital organs will develop. For safety it is better to keep at home, and when walking, carry pyridoxine, or vitamin B6, which acts as an antidote for many poisons and toxins. Then there is a chance to have time to save. Harm does not bring it, because it's a vitamin. Pyridoxine is administered at a rate of 50 mg per kilogram of body weight. More effective will be intravenous administration, if this is not possible, you can enter and intramuscularly. If after the introduction of convulsions stop, and the body improves - this is a good sign. It is necessary to provide further assistance, and the forecast can be favorable. In the absence of a positive reaction, the animal, unfortunately, will die.

If less than an hour has passed since the dog ate the pill, vomiting should be induced along with the administration of the antidote. This will prevent further absorption of the drug, and will remove the residues.

The main signs that indicate isoniazid poisoning in a dog are loss of coordination. The dog also does not orient in space. There is vomiting, drooling, pupils dilate, there may be a shiver. Cramps develop. And in severe cases - paralysis, violation of breathing and heart rhythm. Veterinarians also use various stimulant drugs that allow you to maintain the body: vitamins, glucose, saline.

Complications and consequences

Intoxication with isoniazid is very dangerous. If you do not take timely action, it can end in a fatal outcome.

[30],

Diagnostics of the isoniazid poisoning

Diagnosis is carried out on the basis of a clinical picture of poisoning, subjective sensations, as well as the results of laboratory and instrumental studies.

To confirm poisoning, toxicological examination is used, during which the concentration of isoniazid in the blood serum is determined. The analysis should be specially ordered, as in most laboratories it is not done. The diagnosis of acute poisoning is when the serum concentration of isoniazid is detected more than 10 mg / l. Aminotransferase activity is also monitored.

To determine the chronic form, ultrasound may be required, with the help of which structural and functional disorders of the liver and kidneys are detected.

[31], [32]

Differential diagnosis

Differential diagnosis is based on the definition of a substance that provoked poisoning. This will help toxicology analysis.

Treatment of the isoniazid poisoning

First of all, first aid is necessary. After this, it is necessary to provide vomiting, rinse the stomach, introduce an antidote. This will prevent further intake of poison into the blood, and will also help neutralize the dosage that is already in the blood. After that, supportive therapy is provided, medications are introduced that provide reliable support to the body, stabilize the condition.

When chronic intoxication should immediately stop taking medications, since there is damage to the kidneys and liver, it is necessary first of all to restore their functional state.

Assistance with isoniazid poisoning

The first aid consists in carrying out resuscitation measures, in which it is necessary to stabilize the state of the body, to stop the epileptic fit. After that, the stomach is washed, antidote is introduced. After the threat of life has passed, it is necessary to carry out infusion therapy, adjust and stabilize physiological parameters. Symptomatic therapy is performed, which normalizes the disturbed parameters. To eliminate neurotic symptoms resorted to the introduction of pyridoxine. The amount of pyridoxine should be equal to the amount of isoniazid taken. In particularly severe cases, hemodialysis may be required, but this need rarely occurs.

If there are no pronounced symptoms of an overdose, but a person takes too much of the drug, 5 grams of pyridoxine should be administered to prevent poisoning. After this, the patient should be under medical supervision for at least 6 hours.

Chronic poisoning shows signs of liver damage. At the same time, it is necessary to stop isoniazid as soon as possible. Pyridoxine is not effective, it is necessary to carry out measures aimed at normalizing liver function.

[33], [34], [35]

Antidote for isoniazid poisoning

The antidote is pyridoxine, or vitamin B6, which neutralizes the toxic effect of isoniazid.

[36], [37], [38], [39], [40], [41]

Medications

The main drug is pyridoxine, or vitamin B6, which is an isoniazid antidote. Dosage should correspond to the amount of the drug taken, but the first dose should not exceed 5 g of vitamin. For children, the medicine is given at a rate of 70 mg / kg. Side effects are rare, because it is a vitamin remedy that neutralizes the action of isoniazid. Also, it is administered 50 ml per day to prevent poisoning.

Sorbex is used for purifying the stomach and removing the remains of isoniazid, neutralizing the poison. It is applied at the rate of 1-3 grams per kilogram of body weight. After using the drug you need to drink a lot, you can not eat anything.

Can in the fight against poisoning and activated corner, which is a powerful sorbent and removes poisons from the body. Take 5-6 tablets once, you can dilute with water. In the presence of symptoms of poisoning or intestinal disorders take again after 5-6 hours.

Enterosgel - dilute one tablespoon of the drug in 100-200 ml of water. Drink at a time. After three hours the procedure is repeated. Repeated medication is allowed every 3-4 hours in the first day, then - less often.

Vitamins

First of all, when poisoning with isoniazid, vitamin B6 is recommended, since it is an antidote that neutralizes the action of the poison. Adults recommend a dosage that corresponds to the amount of isoniazid. For children this dosage should not exceed 5 grams.

Also recommend vitamin C, which is a powerful antioxidant, stabilizes the walls of cell membranes, restores energy metabolism of cells. Take in an amount of 500-1000 mg per day.

Physiotherapeutic treatment

Physiotherapeutic treatment for isoniazid poisoning is not carried out, except when there is a need for a recovery phase. Basically at the stage of rehabilitation everything depends on what kind of damage the person received during the poisoning and is determined symptomatically.

Alternative treatment

Alternative treatment in any case should not be used at the first sign of poisoning, otherwise it can result in a fatal outcome. First the patient needs to be provided with qualified help: rinse the stomach, neutralize the effect of the poison. Then, when the threat to life has passed, alternative means for restoration can be used.

Alternative agents can also be used in the first aid phase. For example, in order to induce vomiting and rinse the stomach, drink a solution of salt: 1 salt solution of salt dissolves in a glass of water. Also, a soap solution can be used for this purpose. Vomiting should be abundant and multiple to remove all poisons from the stomach. You can also insert 2 fingers deep into the throat, on the root of the tongue, which causes a vomiting reflex.

To remove the symptoms of inflammation during the recovery period, use a decoction of mint. Mint pour steep boiling water, insist for half an hour, then take. You should drink at least a glass a day. You can also drink in unlimited quantities instead of tea.

A decoction of chamomile is effective, which removes inflammation after resuscitation, eliminates discomfort. To prepare the broth the flowers of chamomile are poured with boiling water, insist for half an hour. Then filter and drink instead of tea.

[42], [43],

Herbal Treatment

When there are cramps and abdominal cramps, spastic vomiting uses the adonis grass of spring. To prepare the broth, take 1 teaspoon of chopped grass and pour a glass of boiling water. After this, allow the agent to brew for an hour, then filter. Drink 1-2 tablespoons three times a day.

Wormwood bitter is used as an oil infusion. To prepare, take 1-2 teaspoons of chopped herbs, pour in sunflower or olive oil, bring to a boil, boil for several minutes with constant stirring, remove from heat. Drink at the appearance of spasms, sharp pains on 1-2 drops, diluting in a tea or tablespoon of water.

Means against nausea, which is accompanied by increased anxiety, fear and increased pressure - lemon balm. To prepare the broth take leaves and flowers of lemon balm, pour boiling water. I insist until a saturated shade appears. Then filter and drink during the day. You can drink like tea, up to 0.5-1 liters per day.

Homeopathy

The use of homeopathic medicines requires a number of precautions. First, it is necessary to take only after first aid is given, and the effect of poison is neutralized. Otherwise, there may be a lethal outcome. Secondly, it is necessary to consult a doctor, since some drugs can not be used with limited nutrition. There are funds that do not combine with other drugs, including sorbents. Some funds begin to work only after they have completed the full course of treatment.

Mumiye is an effective homeopathic remedy that helps purify the body, neutralize and eliminate toxins, prevent intestinal dysfunction, and normalize metabolism. It is used to restore the body's basic functions after poisoning, and other damaging factors. For the preparation of mummy 0.1-0.2 grams of the drug is dissolved in a glass of warm water, give a drink to the patient. The glass is drunk in the morning, on an empty stomach, completely. It is recommended to drink while in bed. After that, lie down or sleep for at least 40 minutes. 

It allows to restore strength and normalize the work of the main propolis organs. An effective infusion of propolis. For cooking take 5-10 grams of propolis, pour a glass of vodka or alcohol. Insist 4-5 days in a dark place. Drink 1 teaspoon twice a day.

Plant poisoning helps to neutralize toxins and soothe inflamed tissues. For cooking, take the herbs of lemon balm, lopant and mint, mix approximately in equal shares. To prepare the broth, take 1-2 tablespoons of the mixture and pour boiling water. Drink like tea for the day.

Juices are used to normalize the body's defenses, increase resistance, accelerate recovery processes. For the preparation of juice take tea or a decoction of mint. It is better to take a decoction or green tea. In it add 50 ml of magnolia juice, 5-10 berries of hawthorn, 2-3 tablespoons of rose hip syrup. Allow to brew for 10-15 minutes. Drink like tea for a day. You can drink 3-4 cups a day.

To restore damage, forces apply tea from sea-buckthorn. To make tea take about 50 grams of sea buckthorn fruit, knead, pour boiling water. Allow to stand for 15-20 minutes. You can add honey to taste. Also add a lemon slice. I drink like tea, 2-3 glasses a day.

Prevention

Prevention of poisoning is reduced to compliance with the recommendations of a doctor. In no case should the recommended dosage be exceeded. With long-term treatment with isoniazid, it is necessary to monitor its concentration in the blood serum using toxicological analysis, and periodically check the liver and kidneys.

To prevent poisoning in domestic animals, you need to hide drugs in places that will not be accessible to animals. Also, dogs should not be allowed to eat food on the street from the ground or the hands of strangers. You should always carry pyridoxine with you, in case the dog gets poisoned. This will make it possible to provide first aid in a timely manner.

[44], [45], [46], [47], [48], [49]

Forecast

If timely measures are taken, correct first aid and treatment, the prognosis may be favorable. If there is no first aid and no treatment, the forecast is unfavorable. Isoniazid poisoning can result in death. More favorable prognosis for acute poisoning. When chronic poisoning occurs, organic and functional damage to the liver, death of hepatocytes. The prognosis depends on the degree of liver damage.

[50], [51]