Isoniazid poisoning: signs, consequences, emergency care

Isoniazid is an antibacterial agent used to treat tuberculosis. It is a potent agent that is classified separately in the pharmaceutical reference book. It is effective against mycobacterium tuberculosis, which cannot be killed by any other means. It has a bacteriostatic effect on microorganisms, but at the same time 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 with prolonged use of the drug. Poisoning often ends in death, since irreversible damage to the heart and breathing develops, severe convulsions and spasms appear. Therefore, isoniazid must be taken strictly according to the scheme prescribed by the doctor.

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Epidemiology

It is absorbed by about 97%, while the antibacterial effect is 90% against mycobacteria, which are the causative agents of the disease. After 6 hours, the concentration in the blood plasma is 50%, and after 24 hours, the drug is not detected in the blood at all. Intoxication is observed in about 57% of patients. In chronic poisoning, signs of hepatitis are diagnosed in 1% of patients, while the mortality rate from liver pathologies is 1.001%.

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Causes isoniazid poisoning

It is very easy to get poisoned by isoniazid, since it is a strong toxic agent and is easily absorbed through the walls of the stomach and intestines. You can get poisoned a day after taking the drug. Another cause may be a deficiency in the body of pyridoxine, which is a natural neutralizer of this agent and an inhibitory mediator of the central nervous system.

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Risk factors

Absolutely all patients who take this medicine are at risk of poisoning. But the greatest probability of poisoning is in those who take the drug for a long time, as well as in children and the elderly. The risk of poisoning is especially high in people who have impaired kidney and liver function, since these organs neutralize and remove toxins. People who have a deficiency of pyridoxine in the body are also at increased risk.

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Pathogenesis

The pathogenesis is based on a disruption of the biochemical cycle, in which the action of the enzyme necessary for the synthesis of acids in the cell wall of mycobacteria is inhibited. These substances inhibit the activity of the microorganism's cell, or kill it completely. In this case, toxic products of the microorganism's vital activity are formed, which, in combination with a high dose of the active substance of the drug, form a toxin that destroys the body's cells. If excretion is disrupted, acute poisoning develops. With prolonged accumulation of toxins inside cells and tissues, poisoning develops gradually, chronically.

The toxic effect is also achieved by a high level of absorption by the body. The drug is absorbed within 2 hours after administration, appears in the blood serum, is carried throughout the body and penetrates all cells and tissues, exerting a toxic effect. It is distributed at a rate of approximately 0.6 liters per kilogram of body weight. The decay products are isonicotinic acid and acetylhydrazine, 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 in various ways. Normally, pyridoxine neutralizes the effect of toxic substances and helps remove them from the body.

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Symptoms isoniazid poisoning

There are two known forms of poisoning: acute and chronic. These forms manifest themselves differently.

In the acute form, severe convulsions and epileptic seizures occur. First aid, which is usually provided for epilepsy, has no effect. The situation worsens, a coma develops. In the early stages, a person may vomit, and coordination of movements is impaired. Severe dizziness suddenly joins in, often leading to loss of consciousness, as well as tachycardia. However, these symptoms do not always occur. Quite often, poisoning manifests itself immediately with a sharp loss of consciousness and an epileptic seizure. This condition can end in a severe coma, the duration of which is from 24 to 36 hours. The coma continues even after the seizure has ended 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 drug use. This causes a large number of pathologies. The simplest form is vomiting and dyspeptic disorders. The most unfavorable option is necrosis of liver hepatocytes, in which the liver not only stops performing its function, but gradually dies. The biochemistry of the body is disrupted, in particular, the level of aminotransferases increases sharply. The danger of this form is that it can proceed asymptomatically for a long time, and will make itself known only with the development of severe damage to internal organs.

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First signs

In the best case, acute poisoning may cause symptoms such as vomiting, dizziness, respiratory and cardiac arrhythmia. In the worst case, the disease develops suddenly, spontaneously, and is accompanied by loss of consciousness, convulsions, and cardiac dysfunction. In 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.

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Stages

Poisoning has two stages. First, internal damage develops, which is asymptomatic and does not manifest itself in any way. This is the latent stage. In the acute form, the biochemical cycle is disrupted, mainly at the cellular and tissue level.

The second stage is obvious, when poisoning manifests itself with clinical symptoms. In the acute form, a seizure or convulsions develop, in the chronic form, liver damage.

The third stage depends on the measures taken. If first aid is provided promptly and correctly and the necessary treatment is carried out, recovery and restoration of the body is possible. If such measures are not taken, a coma develops, then a fatal outcome.

Isoniazid poisoning dose

The lethal dose for oral administration is 20 mg/kg of active substance or more.

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Isoniazid poisoning in humans

Isoniazid causes poisoning when the dosage is exceeded, as well as with prolonged use of the drug. The risk of poisoning increases significantly with impaired kidney and liver function, as well as with a low level of pyridoxine in the body. The danger is that poisoning can end in death (cardiac arrest, prolonged coma, convulsive syndrome).

Isoniazid poisoning in cats

Most often, cat poisoning with isoniazid is an accident. A cat can accidentally eat the medicine because of its curiosity. Poisoning is fatal for a cat, you need to take immediate measures to save its life. To do this, you need to take the injured animal to the veterinarian as quickly as possible. It is impossible to provide assistance at home, so you need to take it to the doctor as quickly as possible. The doctor will determine the cause, if you know for sure that the cat was poisoned with isoniazid, you need to tell the veterinarian about this in order to speed up the provision of assistance. This will help save time and not waste it on diagnostics.

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

Next, an antidote is used - pyridoxine in the form of injections or droppers. If more than two hours have passed since the cat ate isoniazid, it is advisable to immediately begin administering the antidote, since the drug has already entered the circulatory system and there is almost no it in the intestines, respectively, vomiting will not help. You need to give a lot of water and do not give it to drink for 1-2 days.

Cats become lethargic, apathetic, and weak. The cat constantly salivates and has dilated pupils. Spatial orientation is impaired, and it cannot stand on its feet. If you contact a doctor too late and nothing can be done, and there are irreversible disorders in vital organs, it is better to put the animal to sleep immediately, since death from isoniazid is excruciating. The animal begins vomiting blood, becomes very agitated, experiences severe pain, and foams at the mouth. The animal is uncontrollable, scared, and disoriented. After 2-3 days of such torment, the animal stops moving, and its kidneys and liver fail. Incontinence of urine and feces is observed. The danger is that with a strong and young heart, life activity can be maintained for a long time. In this case, the animal experiences excruciating pain. Wounds and ulcers appear on the surface, worms gradually appear, and parasitize on the living cat. Ultimately, the animal will die.

Isoniazid Poisoning in Dogs

Isoniazid poisoning in dogs occurs as a result of an accident, when the drug is accidentally consumed. Sometimes it is intentional - there have been more and more cases of so-called "dog hunters" deliberately poisoning dogs using isoniazid.

Only timely administration of an antidote can help. For dogs, the antidote is pyridoxine, which neutralizes the effect of the poison. To provide first aid, you must immediately go to a veterinary clinic, since animals are often brought in when nothing can be done. From the moment the substance enters the blood, there is exactly one hour to save the animal. Otherwise, irreversible damage to the liver, kidneys and other vital organs will develop. To be on the safe side, it is better to always keep pyridoxine, or vitamin B6, at home and have it with you when walking, which acts as an antidote for many poisons and toxins. Then there is a chance to save it in time. It will not cause harm, since it is a vitamin. Pyridoxine is administered at a rate of 50 mg per kilogram of body weight. Intravenous administration will be more effective, if this is not possible, it can be administered intramuscularly. If after the administration, the convulsions stop and the body's condition improves, this is a good sign. Further assistance must be provided, and the prognosis may be favorable. In the absence of a positive reaction, the animal will, unfortunately, 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 flush out any remaining traces.

The main signs that indicate isoniazid poisoning in dogs are loss of coordination. The dog also becomes disoriented in space. Vomiting and salivation appear, pupils dilate, and tremors may be observed. Convulsions develop. And in severe cases – paralysis, respiratory failure and heart rhythm disturbances. Veterinarians also use various stimulants that help support the body: vitamins, glucose, saline solution.

Complications and consequences

Isoniazid intoxication is very dangerous. If timely measures are not taken, it can result in death.

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Diagnostics isoniazid poisoning

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

To confirm poisoning, a toxicological study is used to determine the concentration of isoniazid in the blood serum. The analysis must be specially ordered, since most laboratories do not do it. The diagnosis of acute poisoning is made when the serum concentration of isoniazid is found to be more than 10 mg/l. Aminotransferase activity is also monitored.

To determine the chronic form, an ultrasound may be required, which can detect structural and functional disorders of the liver and kidneys.

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Differential diagnosis

The basis of differential diagnostics is the determination of the substance that caused the poisoning. Toxicological analysis will help with this.

Treatment isoniazid poisoning

First of all, it is necessary to provide first aid. After that, it is necessary to ensure vomiting, wash the stomach, and administer an antidote. This will prevent further entry 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 administered that provide reliable support to the body, stabilize the condition.

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

Help with isoniazid poisoning

First aid consists of resuscitation measures, which require stabilizing the body's condition and stopping the epileptic seizure. After this, the stomach is washed out and an antidote is administered. After the threat to life has passed, it is necessary to conduct infusion therapy, correct and stabilize physiological parameters. Symptomatic therapy is carried out, which normalizes the abnormal parameters. To eliminate neurotic symptoms, pyridoxine is administered. The amount of pyridoxine should be equal to the amount of isoniazid taken. In particularly severe cases, hemodialysis may be required, but this is rarely necessary.

If there are no obvious symptoms of overdose, but the person has taken too much of the drug, it is necessary to administer 5 grams of pyridoxine to prevent poisoning. After this, the patient should be under the supervision of a doctor for at least 6 hours.

In chronic poisoning, signs of liver damage are detected. In this case, it is necessary to stop taking isoniazid as soon as possible. Pyridoxine is not effective, it is necessary to carry out measures aimed at normalizing liver function.

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Antidote for isoniazid poisoning

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

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Medicines

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

Sorbex is used to cleanse the stomach and remove isoniazid residues, neutralize the poison. It is used at a 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.

Activated carbon, which is a powerful sorbent and removes poisons from the body, can also be used in the fight against poisoning. Take 5-6 tablets at a time, can be diluted with water. If there are symptoms of poisoning or intestinal upset, take again after 5-6 hours.

Enterosgel - dilute one tablespoon of the product in 100-200 ml of water. Drink at once. Repeat the procedure after three hours. Repeated administration of the medicine is allowed every 3-4 hours during the first day, then less often.

Vitamins

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

Vitamin C is also recommended, which is a powerful antioxidant, stabilizes the walls of cell membranes, restores the energy exchange of the cell. Take in the amount of 500-1000 mg per day.

Physiotherapy treatment

Physiotherapeutic treatment for isoniazid poisoning is not carried out, except in cases where it is necessary at the recovery stage. Basically, at the rehabilitation stage, everything depends on what damage a person received during poisoning and is determined symptomatically.

Folk remedies

Folk remedies should never be used at the first signs of poisoning, otherwise it may end in death. First, the patient needs to be given qualified assistance: wash out the stomach, neutralize the effect of the poison. Then, when the threat to life has passed, you can use folk remedies for recovery.

Folk remedies can also be used at the first aid stage. For example, to induce vomiting and wash out the stomach, drink a salt solution: 1 tablespoon of salt is dissolved in a glass of water. A soap solution can also be used for this purpose. Vomiting should be profuse and repeated 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 gag reflex.

To relieve inflammation symptoms during the recovery period, use a mint decoction. Pour boiling water over the mint, let it brew for half an hour, then take it. You need to drink at least a glass a day. You can also drink it instead of tea in unlimited quantities.

Chamomile decoction works well, it relieves inflammation after resuscitation measures, eliminates discomfort. To prepare the decoction, chamomile flowers are poured with boiling water, infused for half an hour. Then filtered and drunk instead of tea.

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Herbal treatment

When cramps and spasms of the abdomen, spastic vomiting occur, use the herb of Adonis vernalis. To prepare a decoction, take 1 teaspoon of chopped herb and pour a glass of boiling water over it. After this, let the remedy brew for an hour, then strain. Drink 1-2 tablespoons three times a day.

Wormwood is used in the form of an oil infusion. To prepare, take 1-2 teaspoons of chopped grass, pour in sunflower or olive oil, bring to a boil, boil for several minutes with constant stirring, remove from heat. Drink 1-2 drops when spasms or sharp pains occur, diluting in a teaspoon or tablespoon of water.

A remedy against nausea, which is accompanied by increased anxiety, fear and high blood pressure - lemon balm. To prepare a decoction, take the leaves and flowers of lemon balm, pour boiling water over them. Infuse until a rich shade appears. Then strain and drink throughout the day. You can drink it like tea, up to 0.5-1 liter per day.

Homeopathy

The use of homeopathic medicines requires a number of precautions. Firstly, they should be taken only after first aid has been provided and the poison has been neutralized. Otherwise, there may be a fatal outcome. Secondly, it is necessary to consult a doctor, since some remedies cannot be used with a limited diet. There are remedies that are not compatible with other drugs, including sorbents. Some remedies begin to act only after a full course of treatment has been completed.

Mumiyo is an effective homeopathic remedy that helps cleanse the body, neutralize and remove toxins, prevent intestinal dysfunction, and normalize metabolism. It is used to restore the body's basic functions after poisoning and other damaging factors. To prepare mumiyo, 0.1-0.2 grams of the drug is dissolved in a glass of warm water and given to the patient to drink. The glass is drunk in the morning, on an empty stomach, completely. It is recommended to drink while in bed. After this, you should lie down or sleep for at least 40 minutes.

Propolis helps to restore strength and normalize the functioning of the main organs. Propolis infusion is effective. To prepare, take 5-10 grams of propolis, pour a glass of vodka or alcohol. Infuse for 4-5 days in a dark place. Drink 1 teaspoon twice a day.

Herbal collection for poisoning helps to neutralize toxins and soothe inflamed tissues. To prepare, take lemon balm, lophanthus and mint, mix in approximately equal proportions. To prepare a decoction, take 1-2 tablespoons of the mixture and pour boiling water over it. Drink like tea throughout the day.

Juices are used to normalize the body's defenses, increase resistance, and speed up recovery processes. To prepare the juice, take mint tea or decoction. It is better to take decoction or green tea. Add 50 ml of lemongrass juice, 5-10 hawthorn berries, 2-3 tablespoons of rosehip syrup. Let it brew for 10-15 minutes. Drink like tea throughout the day. You can drink 3-4 cups a day.

To restore damage and strength, use sea buckthorn tea. To prepare the tea, take about 50 grams of sea buckthorn berries, knead, pour boiling water over them. Allow to brew for 15-20 minutes. You can add honey to taste. Also add a slice of lemon. I drink it like tea, 2-3 glasses a day.

Prevention

Prevention of poisoning comes down to following the doctor's recommendations. The recommended dosage should never be exceeded. During long-term treatment with isoniazid, it is necessary to monitor its concentration in the blood serum using toxicological analysis, and also periodically check the condition of the liver and kidneys.

To prevent poisoning in pets, it is necessary to hide medicines in places that will be inaccessible to animals. Also, dogs should not be allowed to eat food on the street from the ground or from the hands of strangers. You should always carry pyridoxine with you in case the dog is poisoned. This will allow you to provide first aid in a timely manner.

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Forecast

If necessary measures are taken in a timely manner, first aid is provided correctly, and treatment is carried out, the prognosis may be favorable. If first aid is not provided and treatment is absent, the prognosis is unfavorable. Isoniazid poisoning can be fatal. The prognosis is more favorable in acute poisoning. In chronic poisoning, organic and functional liver damage and hepatocyte death occur. The prognosis depends on the degree of liver damage.

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