Some sources say that if the intravenous version is not available, you should give it as a slurry using crushed pills at the same dose. Getting enough pyridoxine might be a problem.It only comes in 50mg vials, so you are going to need A LOT of vials to give the recommended dose Give as a slow infusion of 0.5 grams/min until the seizure stops.If the ingested quantity of isoniazid is unknown, give 5 grams (1 gram/kg in children up to a max of 5 grams).The initial dose should be 1 gram of pyridoxine for every 1 gram of isoniazid ingested (max 5 grams or 70mg/kg in children).I want it on board as soon as possible, but terminating the seizure and managing the ABCs is still my priority. However, pyridoxine, especially in the doses required, will take time to get and give. If there is a suspicion that status epilepticus could be the result of isoniazid toxicity, pyridoxine should be given as soon as possible. The antidote for isoniazid is pyridoxine. However, as soon as possible into the resuscication, I will get the antidote on board: I would also still follow my normal status epilepticus algorithm of benzodiazepine, benzodiazepine, propofol, intubation. My first medication given would still be midazolam (0.1mg/kg IV or 0.2mg/kg intranasal or IM). Get IV access, or if not successful after 2 attempts, place an IO. Address the ABCs, check the sugar, and give benzodiazepines. The initial management of this child is status epilepticus should follow your normal approach to seizures. Could this be an isoniazid overdose? The child is still in an active tonic-clonic seizure as the paramedics transfer him to the resuscitation bay stretcher… Apparently grandma is being treated for tuberculosis, and the pills were all over the ground. You are feeling very confident, but when paramedics role through the door, you encounter a mother screaming about her child being poisoned. You gather all the necessary pediatric equipment and have the broselow tape ready. You gather your team and perform a quick pre-brief, reviewing everyone’s expected role, the algorithm you will follow, and the anticipated pediatric doses. You get a patch from an EMS crew on route with a 3 year old boy in status epilepticus, with 5 minutes of tonic clonic seizure activity unresponsive to the first dose of midazolam.
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