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Isoniazid Hepatitis

Hepatitis Drug Induced Inh


Presentation

  • Since this drug has been associated with hepatic dysfunction in adults, the present study was undertaken to evaluate its effect on liver function in teen-agers.[ncbi.nlm.nih.gov]
  • This is an unusual presentation where both hepatitis and psychosis due to isoniazid occurred together simultaneously. Key words: Isoniazid hepatitis, Isoniazid psychosis Advertisement Applied Medical Research SUBMIT YOUR ARTICLE NOW[scopemed.org]
  • In the present study, transaminase values and anti-HCV status were similar among drinkers and nondrinkers.[natap.org]
  • Mason, MD now presents the fifth edition in full color with new images and highlighted clinical elements.[books.google.com]
  • Always consider drugs as a cause of any patient presenting with hepatitis in order to provide early effective management.[patient.info]
Pain
  • Common side effects may include: red-orange coloration of tears, sweat, saliva, urine, or stools; numbness, tingling, itching, mild rash; drowsiness, dizziness, headache; muscle pain or weakness; heartburn, gas, diarrhea; or mouth pain.[uofmhealth.org]
  • […] or tenderness Blurred vision or loss of vision, with or without eye pain Convulsions (seizures) Joint pain Mental depression Mood or other mental changes Common side effects: tingling of hands and feet nausea/vomiting/diarrhea This is not a complete[rxwiki.com]
  • Seven patients initially experienced excess fatigue, nausea, or abdominal pain, but waited until the onset of jaundice before seeking medical attention.[cdc.gov]
  • […] the risk of bleeding) Anemia High blood sugar levels in the blood Gynecomastia (enlargement of the breasts in men) Ringing in the ears Urinary retention (difficulty passing urine) Blood disorders Hypersensitivity reactions Painful joints What is the[medicinenet.com]
  • Only 6 patients (1.4%; 95% CI, 0.53.2) had symptoms of hepatitis, such as asthenia, nausea, or mild abdominal pain. None of them presented with jaundice or other manifestations that would imply serious hepatitis.[natap.org]
Fatigue
  • A prodromal period characterized by fatigue, weakness, anorexia, and malaise was noted in all patients before the appearance of jaundice.[annals.org]
  • Seven patients initially experienced excess fatigue, nausea, or abdominal pain, but waited until the onset of jaundice before seeking medical attention.[cdc.gov]
  • These include any of the following: unexplained anorexia, nausea, vomiting, dark urine, icterus, rash, persistent paresthesias of the hands and feet, persistant fatigue, weakness or fever of greater than 3 days duration and/or abdominal tenderness, especially[rxwiki.com]
  • […] function tests were performed and information was obtained regarding adverse effects, adherence to preventive therapy, and symptoms of hepatotoxicity (at least 2 of the following: jaundice, dark urine, loss of appetite, nausea, vomiting, pruritis, and fatigue[academic.oup.com]
  • These symptoms and signs include: Unexplained loss of appetite Nausea Vomiting Dark urine Yellow skin or a yellowish tinge to the whites of the eyes Persistent fatigue Weakness Fever of greater than 3 days duration Abdominal tenderness or discomfort,[medicinenet.com]
Acute Intermittent Porphyria
  • Aetiological aspects on primary liver cancer with special regard to alcohol, organic solvents and acute intermittent porphyria — An epidemiological investigation. ‎ Page 283 - Bressac, B., Kew, M., Wands, J., and Ozturk, M. 1991.[books.google.com]
Nausea
  • Seven patients initially experienced excess fatigue, nausea, or abdominal pain, but waited until the onset of jaundice before seeking medical attention.[cdc.gov]
  • Common side effects of Isoniazid include tingling of hands and feet, nausea, vomiting, and diarrhea. Do not drink alcohol while taking isoniazid. Alcohol may increase the risk of liver damage during isoniazid treatment.[rxwiki.com]
  • Patients should be instructed to report immediately any of the prodromal symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea or vomiting.[rxmed.com]
  • Adverse Reactions: Peripheral neuropathy (esp. in slow acetylators), elevated serum transaminases (SGOT; SGPT), bilirubinemia, bilirubinuria, jaundice, hepatitis (may be fatal), nausea, vomiting, epigastric distress, pancreatitis, blood dyscrasias, hypersensitivity[clinicaladvisor.com]
  • Adverse reactions CNS: peripheral neuropathy, dizziness, memory impairment, slurred speech, psychosis, toxic encephalopathy, seizures EENT: visual disturbances GI: nausea, vomiting GU: gynecomastia Hematologic: eosinophilia, methemoglobinemia, hemolytic[medical-dictionary.thefreedictionary.com]
Vomiting
  • Abstract A 22-year-old female who was a known case of tubercular meningitis on anti-tubercular therapy, presented to the emergency room with complaints of recurrent vomiting, markedly reduced appetite, yellowish discoloration of eyes, abnormal behaviour[scopemed.org]
  • Common side effects of Isoniazid include tingling of hands and feet, nausea, vomiting, and diarrhea. Do not drink alcohol while taking isoniazid. Alcohol may increase the risk of liver damage during isoniazid treatment.[rxwiki.com]
  • Patients should be instructed to report immediately any of the prodromal symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea or vomiting.[rxmed.com]
  • ., excess fatigue, nausea, vomiting, abdominal pain, or jaundice), even before a clinical evaluation has been conducted, and that initial symptoms can be subtle and might not include jaundice. Two of the 17 patients in this series were children.[cdc.gov]
  • Adverse Reactions: Peripheral neuropathy (esp. in slow acetylators), elevated serum transaminases (SGOT; SGPT), bilirubinemia, bilirubinuria, jaundice, hepatitis (may be fatal), nausea, vomiting, epigastric distress, pancreatitis, blood dyscrasias, hypersensitivity[clinicaladvisor.com]
Recurrent Vomiting
  • Abstract A 22-year-old female who was a known case of tubercular meningitis on anti-tubercular therapy, presented to the emergency room with complaints of recurrent vomiting, markedly reduced appetite, yellowish discoloration of eyes, abnormal behaviour[scopemed.org]
Jaundice
  • However, jaundice was notably absent in the patients with enzyme elevations and prompted a further investigation into the possible effect of INH on bilirubin metabolism. Thus, Sprague-Dawley rats were given four daily injections of INH.[ncbi.nlm.nih.gov]
  • A prodromal period characterized by fatigue, weakness, anorexia, and malaise was noted in all patients before the appearance of jaundice.[annals.org]
  • ALTHOUGH isoniazid (INH) is thought to be a rare cause of jaundice its precise role is unclear.[nejm.org]
  • , and that initial symptoms can be subtle and might not include jaundice.[cdc.gov]
  • Adverse Reactions: Peripheral neuropathy (esp. in slow acetylators), elevated serum transaminases (SGOT; SGPT), bilirubinemia, bilirubinuria, jaundice, hepatitis (may be fatal), nausea, vomiting, epigastric distress, pancreatitis, blood dyscrasias, hypersensitivity[clinicaladvisor.com]
Scleral Icterus
  • icterus, or “hepatitis” notation 5300 15 (0.37%) b 1 (.019%) Nolan 6 Jan. 1989 to 1 December 1995 Monthly symptom-based screening AST 5x normal with symptoms, and no other cause 11,141 11 (0.1%) 0 LoBue 7 July 1999 to Nov. 2002 Monthly clinical monitoring[mdedge.com]
Pruritus
  • Usually, the onset is abrupt, with chills, fever, rash, pruritus, arthralgia, headache, abdominal pain, anorexia, nausea and vomiting. Later, overt evidence of liver damage, such as jaundice, dark urine and an enlarged and tender liver, may develop.[patient.info]
Delusion
  • A 22-year-old female who was a known case of tubercular meningitis on anti-tubercular therapy, presented to the emergency room with complaints of recurrent vomiting, markedly reduced appetite, yellowish discoloration of eyes, abnormal behaviour and delusion[scopemed.org]
Dark Urine
  • Side Effects of Isoniazid If you experience any of the following symptoms of liver damage, call your doctor immediately: excessive tiredness/weakness lack of energy loss of appetite upset stomach, vomiting dark urine yellowing of the skin or eyes Tell[rxwiki.com]
  • urine for several days 1 146 107 Liver transplant 29 Eczema Rare concurrent alcohol consumption Fatigue, nausea for 2 weeks then icterus, dark urine and jaundice for several days 4 137 16 Death 35 HIV infection, chronic hepatitis C virus infection, eczema[cdc.gov]
  • Later, overt evidence of liver damage, such as jaundice, dark urine and an enlarged and tender liver, may develop. Two general pathogenic mechanisms are recognised: Predictable or direct: usually promptly follows an exposure to a new medication.[patient.info]
  • . • Instruct patient to report anorexia, nausea, vomiting, jaundice, dark urine, and numbness or tingling of hands or feet. • Tell patient he'll need periodic medical and eye examinations and blood tests to gauge drug effects. • As appropriate, review[medical-dictionary.thefreedictionary.com]
  • Call your doctor at once if you have: nausea, upper stomach pain, feeling weak or tired, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); vision changes, confusion, hallucinations, unusual thoughts or behavior[uofmhealth.org]

Workup

Hepatic Necrosis
  • Page 218 - Acetaminophen-induced hepatic necrosis. II. Role of covalent binding in vivo. J. Pharmacol. Exp. Ther. ‎ Page 282 - Acute and chronic effects of aflatoxin on the liver of domestic and laboratory animals. A Review. ‎[books.google.com]
  • necrosis, acute hepatitis and granulomatous hepatitis Cholestatic injury: bland cholestasis, acute cholestatic hepatitis and chronic cholestatic injury Steatosis and steatohepatitis Vascular lesion: sinusoidal obstruction syndrome, Budd-Chiari syndrome[pathologyoutlines.com]
  • This damage is caused by hepatic necrosis or death of liver cells, as Isoniazid is metabolized in the liver. The CYP450 family of enzymes play a key role in the metabolism of the drug (see figure 1).[livertoxicity.weebly.com]

Treatment

  • The efficacy of LTI treatment as a strategy in special-risk groups depends on the risk of developing active tuberculosis disease, the efficacy of the drugs used, and adherence to the treatment regimen.[natap.org]
  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • For comparisons of elevated liver function test values, follow-up extended through 26 weeks of treatment, regardless of HIV status.[academic.oup.com]
  • Hepatitis resolved completely after isoniazid was discontinued and psychosis resolved fully only after treatment with amisulpride was begun.[scopemed.org]
  • Anticipation of the widespread usage of INH in the prevention and treatment of tuberculosis is expected due to the recent increasing incidence of tuberculosis.[karger.com]

Prognosis

  • O'Grady JG, Alexander GJM, Hayllar KM, Williams R: Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97:439–445, 1989 PubMed Google Scholar 13. CDC: Severe isoniazid-associated hepatitis—New York, 1991–1993.[link.springer.com]
  • The risk is higher in women. [ 6, 7 ] Prognosis Usually symptoms subside when the causative drug has been discontinued and drug-related hepatitis subsides within days or weeks after the offending drug is stopped.[patient.info]

Etiology

  • Acute liver disease of any etiology. Warnings/Precautions: Increased risk of severe or fatal hepatitis; monitor, discontinue if signs of hepatic damage detected. Defer in acute hepatic disease. Alcoholics. Chronic liver disease.[clinicaladvisor.com]
  • […] drug exposure varies from hours to months Clinical manifestations range from asymptomatic deranged liver function to fulminant hepatic failure and death Mimic all forms of acute, chronic, vascular or neoplastic liver diseases that are caused by other etiologies[pathologyoutlines.com]
  • Patients who develop severe hypersensitivity reactions to isoniazid, including drug-induced hepatitis; acute liver disease of any etiology.[rxmed.com]

Epidemiology

  • Article navigation 1 Department of Epidemiology, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore Search for other works by this author on: Pankaj Sadaphal 1 Department of Epidemiology, The Bloomberg School of Public Health,[academic.oup.com]
  • Aetiological aspects on primary liver cancer with special regard to alcohol, organic solvents and acute intermittent porphyria — An epidemiological investigation. ‎ Page 283 - Bressac, B., Kew, M., Wands, J., and Ozturk, M. 1991.[books.google.com]
  • About 10% of cases are idiosyncratic. [ 1 ] Epidemiology A very large number of drugs have been implicated as a potential cause of drug-induced hepatitis but with variable risk of both frequency and severity.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Definition / general Drug / toxin reactions can be intrinsic or predictable, where they are dose dependent (e.g. acetaminophen ); or idiosyncratic and unpredictable, where they are dose independent (e.g. isoniazid) Pathophysiology Underlying mechanisms[pathologyoutlines.com]

Prevention

  • Among 3,681 women treated with INH during and after pregnancy to prevent tuberculosis (TB), 5 developed INH hepatitis, and 2 of the 5 women died.[ncbi.nlm.nih.gov]
  • Table 1 Demographic characteristics of 146 persons receiving isoniazid as preventive therapy. Table 1 Demographic characteristics of 146 persons receiving isoniazid as preventive therapy.[academic.oup.com]
  • Anticipation of the widespread usage of INH in the prevention and treatment of tuberculosis is expected due to the recent increasing incidence of tuberculosis.[karger.com]
  • Preventing people from contracting TB in high- risk areas is a goal worth pursuing.[cochrane.org]
  • Isoniazid, also called isonicotinic acid hydrazide (INH), drug used in the treatment and prevention of tuberculosis.[britannica.com]

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