An Acquired Hemorrhagic Disorder From Long-Acting Rodenticide Ingestion

Ross, Glenn S.

doi:10.1001/archinte.1992.00400140146031

Cited by 21 publications

(7 citation statements)

References 11 publications

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“…Difenacoum and brodifacoum can be detected using high performance liquid chromatography 3,4 . An increase in the vitamin K epoxide to vitamin K ratio also supports the diagnosis 3,5 . Finally, an elevated PIVKA II concentration is characteristic of vitamin K deficiency.…”

Section: Discussionmentioning

confidence: 94%

“…The first generation coumarins include warfarin and coumachlor. Second generation coumarins, also known as superwarfarins, were developed in response to increasing rodent resistance to warfarin 1,2,5 . They include the compounds brodifacoum and difenacoum and are readily available from garden centres and hardware stores 3 .…”

Section: Discussionmentioning

confidence: 99%

“…It is a phenomenon that all specialties need to be aware of, because it may present to physicians or surgeons. In 1989, the American Association of Poison Control Centers reported 6116 cases of poisoning by long‐acting anticoagulant rodenticides, of which 178 were intentional 5 …”

Section: Discussionmentioning

confidence: 99%

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Deliberate Self‐poisoning With Rodenticide: A Diagnostic Dilemma

Walker¹,

Beach²

2002

Int J Clinical Practice

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SUMMARYA 71‐year‐old man presented with a recurrent bleeding diathesis requiring frequent blood transfusions, vitamin K and fresh frozen plasma. Extensive investigations revealed vitamin K deficiency. After repeated interviews the patient admitted to deliberately ingesting rat poison. Superwarfarins are an uncommon cause of deranged clotting and specialised tests are available to identify them. They can cause prolonged coagulation abnormalities and may require treatment with oral vitamin K for several months after just a single dose.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Deliberate Self‐poisoning With Rodenticide: A Diagnostic Dilemma

Walker¹,

Beach²

2002

Int J Clinical Practice

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“…In humans, it has also been reported to have a biphasic hepatic elimination. Haemorrhage of skin mucosa, digestive tract and urine are the most common symptoms of super‐warfarin poisoning . Bromadiolone is a widely used super‐warfarin for rodent control all over the world.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Bromadiolone poisoning leading to subarachnoid haemorrhage: A case report and review of the literature

et al. 2019

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Super-warfarins, as second-generation dicoumarin rodenticides, were developed to overcome the resistance of warfarin in rodents.super-warfarins are designed on the chemical structure modification of warfarin. These new super-warfarins characterized with longer half-lives and stronger affinity to vitamin K 2, 3-epoxide reductase enzyme. The increased inactive form of vitamin K will impair the vitamin K-dependent clotting factors and disrupt the normal clotting process. 1,2 In humans, it has also been reported to have a biphasic hepatic elimination. Haemorrhage of skin mucosa, digestive tract and urine are the most common symptoms of super-warfarin Abstract What is known and objective: Many cases of rodenticide poisoning have been reported. Bromadiolone, often called a super-warfarin, is a second-generation dicoumarin rodenticide with long half-life. The main clinical manifestations of bromadiolone poisoning are excessive or inappropriate bleeding of skin mucosa, digestive tract and urinary tract. However, the phenomenon of central nervous system (CNS) toxicity is an uncommon medical emergency. We present a case of SAH and intracerebral haematoma mediated by bromadiolone intoxication, revealing that bromadiolone poisoning might cause intracerebral haematoma. Case description: A 44-year-old woman presented with skin mucosa haemorrhage and haematuresis initially. The patient developed lethargy, headache, nausea and vomiting. The toxicology test result revealed that the presence of bromadiolone in her blood. Coagulation test results showed a longer prothrombin time (PT), activated partial thromboplastin time (APTT) and a high international normalized ratio (INR).SAH, frontal lobe haematoma, midline shift and brain oedema were discovered by skull CT examination. The coagulation disorders were addressed after the treatment of vitamin K and fresh frozen plasma. The intracranial symptoms were relieved after surgery and the treatment with mannitol. What is new and conclusion:This case suggests that bromadiolone poisoning should be diagnosed and treated as early as possible. Bromadiolone poisoning might cause SAH and intracerebral haematoma, which is rare but potentially lethal. It is important to strengthen the diagnosis and post-treatment monitoring. K E Y W O R D Sbromadiolone, case report, rodenticide, subarachnoid haemorrhage, vitamin K | 959

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“…To combat resistance in rodents, scientists developed a "superwarfarin" or a long-acting anticoagulant rodenticide (LAAR) [4]. Previous reports describe hematemesis, hematuria, hematomas, epistaxis, melena, vaginal bleeding, and hemoptysis from alveolar hemorrhage leading to death in some cases of human ingestion [5][6][7][8][9][10][11][12][13][14]. Here, we report a case of life threatening bleeding caused by LAAR and treatment with fixed-dose 4-factor prothrombin complex concentrate (PCC).…”

Section: Accepted Manuscript Title Pagementioning

confidence: 99%