Isoniazid overdose is known to result in the rapid onset of
seizures, metabolic acidosis, and prolonged obtundation. Pyridoxine has been reported to be effective in treating isoniazidinduced seizures. We report three cases of obtundation secondary to isoniazid overdose that was immediately reversed by
intravenous pyridoxine. In two of these cases, status seizures
were stopped by intravenous pyridoxine administration, but the
patients remained comatose for prolonged periods. The comas
were immediately reversed by the administration of additional
pyridoxine. In the third case, the patient's lethargy was treated by
intravenous pyridoxine on presentation and was followed by
immediate awakening. Pyridoxine is effective in treating not only
isoniazid-induced seizures, but also the mental status changes
associated with this overdose. The dose required to induce
awakening may be higher than that required to control seizures.
(Arch Intern Med. 1990;150:1751-1753)
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