bromfenacoum and Hematemesis

Topics: 4-Hydroxycoumarins; Abdominal Pain; Adult; Ecchymosis; Epistaxis; Female; Hematemesis; Hematoma; Hematuria; Humans; Male; Public Health; Rodenticides; Social Problems

Recent outbreaks of brodifacoum-induced coagulopathy resulting from the use of synthetic cannabinoids represents a growing public health concern. Brodifacoum is a commonly used and commercially available rodenticide that has anticoagulant properties. As new, unregulated synthetic cannabinoids enter the market, the potential for further outbreaks continues to rise.. We report a case of severe bleeding secondary to inhalation of synthetic cannabinoids contaminated with brodifacoum. The patient had been evaluated for several months of ongoing, unexplained vaginal bleeding and developed hematemesis and rectal bleeding 2 weeks after her last reported use.. There have been previous reports of hemorrhage after exposure to synthetic marijuana in rare cases, including an outbreak of severe bleeding and reported synthetic marijuana use in the Midwestern region of the United States in 2018.. While hemorrhaging after exposure to synthetic cannabinoids has been reported previously, we use this case to increase awareness of the potentially deadly exposures to brodifacoum from synthetic cannabinoids use in Wisconsin. By increasing awareness, emergency department physicians and state agencies can collaborate more effectively when responding in these cases.

Topics: 4-Hydroxycoumarins; Administration, Inhalation; Adult; Cannabinoids; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Rodenticides; Uterine Hemorrhage; Wisconsin

Topics: 4-Hydroxycoumarins; Adult; Anticoagulants; Diagnosis, Differential; Epistaxis; Female; Hematemesis; Humans; Partial Thromboplastin Time; Pesticides; Poisoning; Prothrombin Time; Thrombosis; Unconsciousness; Vitamin K; Vitamin K Deficiency

The authors present the case of a 44-year-old American Indian woman with hematemesis, spontaneous cutaneous hemorrhages, and multiple ecchymoses. Coagulation factor analyses demonstrated both prolonged prothrombin time (PT, >40 s) and prolonged partial thromboplastin time (PTT, >120 s). Measurement of the serum level of brodifacoum (37 ng/mL), one of the superwarfarin agents commonly used in rodenticides, confirmed poisoning as the cause of the patient's symptoms. Substantial amounts of fresh frozen plasma and vitamin K were required to obtain normal coagulation parameters and maintain these parameters over a 3-week inhospital period. Oral administration of vitamin K (100 mg daily) maintained normal PT (14.1 s), PTT (33.0 s), and international normalized ratio (INR, 1.48) at 2 weeks after the patient was discharged from the hospital. By 2 months postdischarge, PT, PTT, and INR returned to elevated levels because of patient noncompliance with the prescribed tapering vitamin K regimen.

Topics: 4-Hydroxycoumarins; Adult; Anticoagulants; Female; Hematemesis; Hemorrhage; Humans; Poisoning; Skin Diseases