head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2022, vol. 28, issue3
Subject Area: Medicine
DOI: 10.5272/jimab.2022283.4487
Published online: 28 July 2022

Case report
J of IMAB. 2022 Jul-Sep;28(3):4487-4490
Evgenia Barzashka1, 2ORCID logo, Vasil Atanasov3, 4ORCID logo, Teodora Valova5ORCID logo Corresponding Autoremail, Olimpiada Atmazhova1ORCID logo,
1) Clinic of Toxicology, UMHAT "Dr G. Stranski", Medical University – Pleven, Bulgaria.
2) Department of Social and Pharmaceutical Activities, Medical University – Pleven, Bulgaria.
3) Department of Clinical Toxicology, Forensic Toxicology Laboratory, Military Medical Academy, Sofia, Bulgaria.
4) Department of Analytical Chemistry, Faculty of Chemistry and Pharmacy, Sofia University "St. Kliment Ohridski", Sofia, Bulgaria.
5) Department of Medico-diagnostic Investigations, Medical University – Pleven, Bulgaria.

Rimicid or isonide a group of medications which belong to anti-tuberculosis medicaments. The active substance isoniazid is used to treat pulmonary and extrapulmonary forms of tuberculosis, as well as prophylaxis in case of contact with infected individuals.
Isoniazid is rapidly absorbed, reaching a maximum serum concentration in 2 hours, and penetrates all body fluids. The volume of distribution is approximately 0.6 l/kg.
Isoniazid causes pyridoxine deficiency in two ways:
- by hydrazones, isoniazid metabolites inhibit the pyridoxal kinase, which converts pyridoxine to the active form, pyridoxal-5-phosphate, and
- pyridoxine deficiency disrupts the synthesis and metabolism of GABA, the main inhibitory mediator of the central nervous system.
Isonicotinic acid poisoning metabolism is subject to individualized factors, and in some people, this metabolism can be in a significantly slower.
A clinical case of poisoning with 30 tablets of Rimicid by a 16-year-old girl suicidal attempt was presented. The results of the TC analysis confirm intoxication with the drug, and the retrospective assessment of the concentration over a past period of time using the elimination half-life has revealed an extremely high dose of ingested isoniazid.

Keywords: isoniazid, pyridoxine, poisoning,

pdf - Download FULL TEXT /PDF 493 KB/
Please cite this article as: Barzashka E, Atanasov V, Valova T, Atmazhova O. Acute Izoniazid Poisoning with Presentation of a Clinical Case. J of IMAB. 2022 Jul-Sep;28(3):4487-4490.
DOI: 10.5272/jimab.2022283.4487

Corresponding AutorCorrespondence to: Teodora Valova, Department of Medico-diagnostic Investigations, Medical University – Pleven; 1, Sv. Kliment Ohridski Str., 5800 Pleven, Bulgaria; E-mail: Teodora.Valova@mu-pleven.bg

1. Monov A. [Clinical toxicology.] Vol. 1. Venel, Sofia. 1995: pp.85-90. [in Bulgarian]
2. Ellenhorn MJ. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. 2nd Edition. Schonwald S, Ordog G, Wasserberger J. (Editors). Williams & Wilkins. January 1, 1997. [Internet]
3. Alao AO, Yolles JC. Isoniazid-induced psychosis. Ann Pharmacother. 1998 Sep;32(9):889-91. [PubMed]
4. Steichen O, Martinez-Almoyna L, De Broucker T. [Isoniazid induced neuropathy: consider prevention.] [in French] Rev Mal Respir. 2006 Apr;23(2 Pt 1):157-60. [PubMed]
5. Iannaccone R, Sue YJ, Avner JR. Suicidal psychosis secondary to isoniazid. Pediatr Emerg Care. 2002 Feb;18(1):25-7. [PubMed]
6. Luzhnikov E. [Medical toxicology.] Moskva: Publishing group: GEOTAR-Media. 2012: 265, 271, 314. [in Russian]
7. Trevor A, Katzung B, Masters S, Knuidering-Hall M. ;Katzung & Trevor's Pharmacology Examination and Board Review. 10th Edition. (Lange Medical Books) McGraw-Hill Education / Medical. December 21, 2012. [Internet]
8. Sykes JE, Gunn-Moore DA. Chapter 44 - Mycobacterial Infections. In: Canine and Feline Infectious Diseases. Part II. Section 2: Bacterial Diseases. Elsevier. 2014. p.425. [Crossref]
9. Hoffman R, Nelson L, Howland M-E, Lewin N, Flomenbau.m N, Goldfrank L. Goldfrank's Manual Toxicologic Emergencies. McGRAW-HILL Medical. 2010; pp.734-739. [Crossref]
10. Trends and Changes in Drug Research and Development. Walker SR, editor. Springer. October 1, 2011. [Internet]
11. Hamilton RJ. Tarascon Pocket Pharmacopoeia 2020 Deluxe Lab-Coat Edition. 21st Edition. Kindle Edition. Jones & Bartlett Learning. April 30, 2020. [Internet]
12. Shah I, Jadhao N, Mali N, Deshpande S, Gogtay N, Thatte U. Pharmacokinetics of isoniazid in Indian children with tuberculosis on daily treatment. Int J Tuberc Lung Dis. 2019 Jan 1;23(1):52-7. [PubMed]
13. Moncrieff J. The creation of the concept of an antidepressant: an historical analysis. Soc Sci Med. 2008 Jun;66(11):2346-55. [PubMed]
14. Villar D, Knight MK, Holding J, Barret GH, Buck WB. Treatment of acute isoniazid overdose in dogs. Vet Hum Toxicol. 1995 Oct;37(5):473-7.[PubMed]
15. Polat E, Senel S. Suicide attempt with isoniazid in adolescents receiving tuberculous prophylaxis: three cases. Paediatr Int Child Health. 2021 Aug;41(3):228-230. [PubMed]
16. William Andrew Publishing. Pharmaceutical Manufacturing Encyclopedia (3rd ed.). Norwich, NY: Elsevier Science. 2008:1968-1970.
17. Asiimwe E, Koh M, Patel R. A Case of Accidental Isoniazid Overdose Presenting With Non-specific Symptoms. Cureus. 2022 Mar 16;14(3):e23218. [PubMed]
18. Cade CE, Dlouhy AC, Medzihradszky KF, Salas-Castillo SP, Ghiladi RA. Isoniazid-resistance conferring mutations in Mycobacterium tuberculosis KatG: catalase, peroxidase, and INH-NADH adduct formation activities. Protein Sci. 2010 Mar;19(3):458-74. [PubMed]
19. Aleksandrov N. [Practical emergency toxicology.] Sofia: Znanie. 2000: 63-66. [in Bulgarian]
20. Rozwarski DA, Grant GA, Barton DH, Jacobs WR Jr, Sacchettini JC. Modification of the NADH of the isoniazid target (InhA) from Mycobacterium tuberculosis. Science. 1998 Jan 2;279(5347):98-102. [PubMed]
21. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017 Jan;112(1):18-35. [PubMed ]
22. Mihov Hr, Shmilev T. [Poisonings and accidents in childhood.] Plovdiv: Vasil Petrov. 2003: 269-271. [in Bulgarian]
23. Sekaggya-Wiltshire C, von Braun A, Scherrer AU, Manabe YC, Buzibye A, Muller D, et al. Anti-TB drug concentrations and drug-associated toxicities among TB/HIV-coinfected patients. J Antimicrob Chemother. 2017 Apr 1;72(4):1172–1177. [PubMed]
24. D’Orazio JL, Hayoun MA. Isoniazid Toxicity Clinical Presentation. Medscape. Feb 07. 2019. [Internet]

Received: 18 January 2022
Published online: 28 July 2022

back to Online Journal