PPT-Isoniazid induced Acute Metabolic Acidosis and Neurotoxicity–A Case Report and

Review of Literature Sumeet Prakash Mirgh Jehangir Soli Sorabjee Isoniazid INH is a crucial drug in the prevention and treatment of tuberculosis INH is commonly known to cause derangements in liver function tests and peripheral neuropathy due to pyridoxine deficiency in slow acetylators However in toxic doses it is known to cause severe neurologic manifestations and acute metabolic acidosis INH toxicity is characterized by the clinical triad of repetitive seizures unresponsive to the usual anticonvulsants metabolic acidosis with a high anion gap and coma Hence the diagnosis of INH overdose should be considered in any patient who presents to Emergency medical services EMS with the triad Though accidental overdose of antituberculosis drugs have been reported in children and adults acute toxicity is rare When recognized intravenous pyridoxine and correction of acidosis with sodium bicarbonate and supportive treatment is effective The condition is easily treated with intravenous pyridoxine but if not treated in time could prove fatal Unlike other poisonings serum INH levels do not corelate with either symptomatology or liver injury. W. Rose. See . Marieb. & . Hoehn. 9. th. ed., Chapter 26 . Normal Arterial Blood Gas. pH = 7.35-7.45. P. a. CO. 2. = 35-45 . mmHg. HCO. 3. -. = 22-26 . mEq. /L. P. a. O. 2. = 80-100 . mmHg. ICU SRMO. Sodium Bicarbonate . - use in critical care. Metabolic Acidosis. Hyperkalaemia. Toxicology. Cardiac arrest. RTA. CRRT. Others?. Potential Sodium Bicarbonate Uses:. NaHCO3. Available in 8.4% solution, 10/50/100 ml. Prof. Tahir . Shafi. Why should we know about acid base disorders. What are acid base disorders. How to interpret acid base disorder. How to establish the cause. Why to worry about acid base disorders. Dr. . Nawal. . Makhseed. . MBBS, FAAP, FRCPC, DABMGG, FCCMG. Pediatric Metabolic Consultant. Second . Jahra. Pediatric conference 5-6 May/2017 . What is a metabolic disease?. Small molecule disease. Combined EM/IM Residency Program. Virginia Commonwealth University Health System. Overview. Physiologic Effects of Acid-Base Disturbances. Traditional (Schwartz-Bartter) Approach. Stewart Method. Fluid Resuscitation. Objectives. Understand normal mechanisms and regulation of acid-base balance. Interpret blood gases. Understand the effects of acidosis and alkalosis. Evaluate and manage acidosis and alkalosis. Normal Physiology. AHMED BAMAGA. MBBS. King Abdulaziz University Hospital. ABG Interpretation. 2. ABG Interpretation. First, does the patient have an acidosis or an alkalosis. Second, what is the primary problem – metabolic or respiratory. Alok Agrawal, MD, FASN, FNKF. Clinical Associate Professor. WSU, Dayton, Ohio. Arterial Blood Gas. ABG’s - necessary to correctly diagnose AB disorders. Interpret ABG s in conjunction with history, PE and labs. to. + 2.5 mmol/L. BE (base excess). is defined as the amount of acid that would be added to blood to titrate it to pH 7.4 at pCO. 2. . = 40 mmHg. . positive value = base excess . negative value = base deficit (BD). Abdullah Alsakka . EM.Consutant. . . . Objectives . To provide a simple, systematic approach to interpreting arterial blood gas (ABG) samples. . Multiple formulas and rules exist to help guide us through the forest of diagnoses and complex problems. OBJECTIVES. Pharmacology. Metabolic . Acidemia. Urinary . Alkalinization. Cardiotoxic. drug intoxication. ?Hyperkalemia. Fun with . Bicarb. pharmacology. Saleratus. Latin for “aerated salt”. aka baking soda, bread soda, and . Critical Care Clinical Fellow. Royal Papworth Hospital. Metabolic Acidosis: Anion Gap. [Na. +. ] - [Cl. -. ] - [HCO. 3. -. ]. Reference range 8 – 12 (+/- 4) mmol/L. Sometimes [K. +. ] is included:. Acid-Base Disorders. Acid-base homeostasis. Henderson-Hasellbach formula. Normal lab values. pH = 7,36 - 7,44. HCO. 3. = 24 mEq/L (22-30). pCO. 2. = 40 mmHg (36-40). AG = 12 mEq/L (. 10-14. ). Osmolar. MOHAMMED YOUNUS AL ATBEE. Consultant nephrologist and physician . Assistant professor of medicine and nephrology. Interactive session . Definitions. The acidity or alkalinity of a solution is determined by its Hydrogen ion concentration.