vitamin-k-semiquinone-radical and Poisoning

The increased prevalence of rodents resistant to warfarin led to the development of the hydroxycoumarin anticoagulant brodifacoum. A 25-year-old man attempted suicide by consuming four boxes of d-CON Mouse-Prufe II; each box contains 42 g of bait that is 0.005% brodifacoum. He presented to a hospital nine days later with syncope, hematochezia, gross hematuria, epistaxis, anemia, and a severe coagulopathy. Radiographic studies were consistent with pleural, pericardial, and mediastinal hemorrhages. Vitamin K and fresh frozen plasma were given, and he was later discharged on oral phytonadione (vitamin K1). The patient's coagulopathy recurred, necessitating multiple plasma transfusions and prolonged treatment with oral phytonadione. Fifteen weeks after hospital discharge, he presented again with a history of additional brodifacoum ingestion. Neurologic status was initially normal, but in the emergency department he suddenly became comatose soon after emesis was induced with syrup of ipecac. Computed tomography of the brain revealed a subarachnoid hemorrhage that led to brain death less than 24 hours later. This case demonstrates the severe and prolonged coagulopathy that can result from ingestion of brodifacoum, a compound that has a toxic potency about 200-fold that of warfarin and a half-life as much as 60 times longer.

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Disorders; Blood Transfusion; Drug Overdose; Emergency Service, Hospital; Humans; Ipecac; Male; Partial Thromboplastin Time; Patient Readmission; Phenobarbital; Plasma; Poisoning; Prothrombin Time; Rodenticides; Subarachnoid Hemorrhage; Suicide; Tomography, X-Ray Computed; Vitamin K

Topics: 4-Hydroxycoumarins; Adult; Female; Humans; Poisoning; Rodenticides; Vitamin K

Topics: Administration, Oral; Anticoagulants; Blood Coagulation Tests; Coumarins; Heparin; Humans; Indenes; Infusions, Parenteral; Poisoning; Protamines; Prothrombin Time; Pulmonary Embolism; Thromboembolism; Vitamin K

Topics: Adrenal Cortex Hormones; Analgesics; Analgesics, Non-Narcotic; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antipyretics; Antitubercular Agents; Child; Chloramphenicol; Diuretics; Erythromycin; Histamine H1 Antagonists; Infant; Poisoning; Psychopharmacology; Sulfonamides; Tetracycline; Toxicology; Vitamin K; Vitamins

We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K.. We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded. Forty-eight- to 96-hour prothrombin time or international normalized ratio (INR) blood tests were recommended, and telephone contact was attempted at least 3 days after ingestion.. A total of 595 consecutive patients were enrolled during the 16-month study period. Fifty patients were excluded: 8 who were known to have ingested 1 pellet or less; 25 who received activated charcoal; 15 who were treated with induced emesis; and 2 who received prophylactic vitamin K. The resulting study group contained 545 patients. Eighty-two patients were lost to follow-up. Follow-up was obtained for 463 patients, including 222 by telephone contact alone, 62 by 48- to 96-hour INR, and 179 by both methods. None of the patients had clinically important coagulopathy. Two patients had an INR of 1.5 or greater (1.5 and 1.8) without symptoms. Single nosebleeds were reported in another 2 patients with normal 48-hour INRs. Another child had a small amount of blood crusted in the nose with no other symptoms and no laboratory work available. One child with a normal 48-hour INR had blood-streaked stools that were thought to be caused by an anal fissure.. Children with acute unintentional superwarfarin ingestions of less than 1 box may be managed without gastric decontamination or prophylactic vitamin K. Laboratory testing for coagulopathy should be reserved for cases involving clinically evident bleeding abnormalities.

Topics: 4-Hydroxycoumarins; Anticoagulants; Child; Child, Preschool; Decontamination; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Male; Poisoning; Prospective Studies; Prothrombin Time; Rodenticides; Treatment Outcome; Vitamin K

A randomised clinical trial was undertaken to compare the value of a factor II, IX, and X concentrate (Prothromplex) with intravenous vitamin K1 (2-5 mg) in reversing an overdose of oral anticoagulants. Rapid partial correction of the prothrombin time, partial thromboplastin time, and the clotting factor assays were observed with the concentrate, but these changes were not always sustained. In contrast vitamin K1 did not show any great effect at two hours but at 24 hours there was always over-correction despite the conservative dosage, prothrombin times being shorter than the therapeutic range. The prothrombin complex concentrate provides a quicker, more controlled but less sustained method of reversing the coumarin defect than vitamin K1. But there remains a significant risk of hepatitis even with a preparation for which strenuous efforts have been made to minimise this risk by screening for hepatitis B virus. The risk should be carefully considered before such concentrates are infused in non-urgent conditions.

Topics: Anticoagulants; Chemical and Drug Induced Liver Injury; Clinical Trials as Topic; Drug Combinations; Factor IX; Factor X; Humans; Poisoning; Prothrombin; Prothrombin Time; Thromboplastin; Time Factors; Vitamin K

Warfarin- and superwarfarin-type anticoagulants are commonly used as rodenticides. Exposure to these agents, especially superwarfarins with long-acting anticoagulant effect, can cause life-threatening coagulopathy in humans. Most superwarfarin poisoning cases had an obvious history of exposure, though occult cases without exposure history have also been reported. The current study aims to examine anticoagulant-type rodenticide poisoning in Hong Kong and to identify the similarities and differences between patients with known exposure history and those whose exposure is recognized only through laboratory testing.. The present study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. This was a retrospective cohort study of all patients with biochemically confirmed anticoagulant-type rodenticide exposure, from 2010 to 2014.. Superwarfarin was the most common group of anticoagulant-type rodenticides identified (87.8%), in which bromadiolone and brodifacoum were the most frequently encountered. Among the 41 cases identified, 31 had an obvious exposure history, and 10 were occult poisoning in which the context of exposure remained unidentified. All occult poisoning patients without exposure history presented with bleeding events. These occult poisoning cases often went unrecognized by frontline clinicians, leading to delayed investigation and initiation of treatment. This group of patients was associated with a longer time to diagnose coagulopathy (p < 0.001) and confirm rodenticide poisoning (p < 0.05), a higher rate of international normalized ratio (INR) rebound after initiation of antidote (p < 0.001), and a longer time needed for normalizing INR (p < 0.05).. Occult superwarfarin poisoning is an important yet under-recognized differential cause of unexplained coagulopathy. A high index of clinical suspicion and availability of specialized toxicological test for superwarfarins play a vital role in diagnosis and early initiation of appropriate management. The underlying cause of such poisoning remains obscure and warrants further study.

Topics: 4-Hydroxycoumarins; Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Disorders; Cohort Studies; Female; Hemorrhage; Hong Kong; Humans; Infant; International Normalized Ratio; Male; Middle Aged; Poisoning; Retrospective Studies; Rodenticides; Vitamin K; Warfarin; Young Adult

Synthetic marijuana is a dangerous substance due to its potency, ever-changing composition, and unpredictable side effects. Recently, brodifacoum-contaminated synthetic marijuana has led to multiple deaths and morbidity throughout the USA from severe coagulopathy associated with use of this strain of the drug (brodifacoum is a rodenticide and potent Vitamin K antagonist/anticoagulant). We describe the clinical and radiologic findings in two patients who were diagnosed with, and treated for, ingestion of this new strain of synthetic marijuana. The radiologic manifestations were most notable for hemorrhagic pyelitis/ureteritis. Both patients required hospitalization with Vitamin K supplementation. The radiologic and clinical pictures in these patients are important for radiologists to recognize in order to help guide appropriate patient management.

Topics: 4-Hydroxycoumarins; Adult; Baltimore; Blood Coagulation Disorders; Cannabinoids; Diagnosis, Differential; Disease Outbreaks; Female; Humans; Illicit Drugs; Male; Middle Aged; Poisoning; Rodenticides; Tomography, X-Ray Computed; Vitamin K

Superwarfarin, a common component of rat poison, can cause long-lasting, severe coagulopathy and life-threatening hemorrhage when ingested. We report a case of intentional rat poison consumption with subsequent hemorrhage and hypotension requiring rapid coagulopathy reversal and resuscitation in the emergency department. In addition to traditional blood products, prothrombin complex concentrate was administered. Although prothrombin complex concentrate is increasingly used for severe hemorrhage in anticoagulated patients, it may be particularly useful in superwarfarin ingestions given the extreme, persistent coagulapathies that can occur.

Topics: Anticoagulants; Blood Coagulation Factors; Humans; Male; Middle Aged; Poisoning; Vitamin K; Warfarin

Superwarfarins (brodifacoum, difenacoum, bromodialone and chlorphacinone) are anticoagulant rodenticides that were developed in 1970s to overcome resistance to warfarin in rats. A 26-year-old previously healthy man was admitted to the emergency department with epigastric pain, severe upper and lower gastrointestinal haemorrhage, gingival bleeding and melena. The patient stated that he had been healthy with no prior hospital admissions and no personal or family history of bleeding diathesis. The patient, who later admitted attempted suicide, stated that he had taken 400 g rodenticide including brodifacoum orally for five days prior to admission to hospital. He had oral mucosal bleeding, numerous bruises over the arms, legs and abdomen, and an abdominal tenderness, together with melena. Laboratory tests revealed a haemoglobin level of 12.3 g/dl, leucocyte count of 9.1 × 10(9) /l, haematocrit of 28% and platelet count of 280 × 10(9) /l. The prothrombin time (PT) was > 200 s (normal range 10.5-15.2 s) and the activated partial thromboplastin time (aPTT) was 91 s (normal range 20-45 s). The INR (International normalised ratio) was reported to be > 17 (normal range 0.8-1.2). The thrombin time and plasma fibrinogen levels were in the normal range. The results showed the presence of brodifacoum at a concentration of 61 ng/ml, detected by reversed-phase liquid chromatography.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; 4-Hydroxycoumarins; Adult; Animals; Anti-Ulcer Agents; Anticoagulants; Blood Coagulation Disorders; Emergency Service, Hospital; Gastrointestinal Hemorrhage; Humans; Male; Pantoprazole; Partial Thromboplastin Time; Poisoning; Prothrombin; Rats; Rodenticides; Suicide, Attempted; Treatment Outcome; Vitamin K

Topics: Aged, 80 and over; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Coagulants; Cytochrome P-450 CYP2C9; Female; Genotype; Humans; Poisoning; Treatment Outcome; Vitamin K; Warfarin

We report a patient who attempted suicide by taking warfarin as a coumarin rodenticide twice, and showed oral bleeding and an abnormally prolonged bleeding tendency after 10 days. He was conscious. His body temperature was 36.6 degrees C, the respiratory rate was 23/min, and blood pressure was 142/87 mmHg. A bite wound showing continuous bleeding was observed on the right side of the oral cavity. CT of the head and upper gastrointestinal endoscopy showed no intracranial and gastrointestinal bleeding,respectively. The PT and INR were extremely high, and complete blood count revealed anemia. Blood chemistry showed hypoproteinemia. Occult blood was strongly positive. Routine urine examination and electrocardiography showed neither abnormal nor characteristic findings. In drug/ poison screening tests, GC/MS analysis revealed warfarin artifacts in serum and urine samples. Warfarin was isolated from each sample, converted to a TMS derivative, and quantified by SIM analysis of GC/MS. During the clinical course, KaytwoN (vitamin K) was intravenously administered at a dose of 20 mg since the INR at the first consultation was 20.89. After admission to the ICU, 20 mg Kaywan (vitamin K) was orally administered, and the INR after 5 hours improved to 2.32. Kaywan administration (20 mg/day) was initiated, and he improved and was discharged 5 days after admission. The definite cause could be clarified by drug/poison analysis, and effective treatment could be performed.

Topics: Antifibrinolytic Agents; Coumarins; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Poisoning; Rodenticides; Suicide, Attempted; Treatment Outcome; Vitamin K; Warfarin

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

Superwarfarin poisoning is considered a significant public health problem in the US. In 2004, there were 16,054 cases of poisoning; most were accidental ingestions of rat bait by children but 4576 patients required hospital treatment, 23 patients had major adverse outcomes and 1 patient died. Similar information is unavailable for the UK. The National Poisons Information Service is presently auditing cases. The case of a farmer who presented with haematuria, 9 days after spilling a rodenticide containing a superwarfarin over himself is reported here. He was physically well except for mild abdominal tenderness. He had grossly deranged clotting studies (prothrombin time (PT) >200 s, activated partial thromboplastin time (APTT) 56 s) that were rapidly corrected with fresh frozen plasma and vitamin K. He was sent home after 5 days without follow up. Unfortunately, he presented again 2 days later, again with haematuria and an international normalised ratio (INR) >10. He required inpatient treatment with high-dose vitamin K for 1 week. Upon discharge, he required daily vitamin K and INR monitoring for a further month. The original inpatient team had not identified the specific poison (chlorophacinone). They were unaware that superwarfarins are more potent and longer acting than warfarin, with toxic effects for weeks or even months, and that large doses of vitamin K are often required.

Topics: Hematuria; Humans; International Normalized Ratio; Male; Middle Aged; Poisoning; Prothrombin Time; Recurrence; Rodenticides; Vitamin K; Warfarin

Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Dyspnea; Male; Poisoning; Radiography, Thoracic; Rodenticides; Treatment Outcome; Ultrasonography, Doppler, Color; Vitamin K

A 55-year-old man came to the hospital with a bleeding wound on his tongue. The coating of his tongue was green, and his sputum was red. Because an increased international normalized ratio-value was measured, a blood sample was sent to our laboratory with the suspicion of coumarin intoxication. Liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) analysis confirmed the poisoning was by bromadiolone, with its maximum serum concentration at 440 microg/L. The analysis of further samples resulted in a calculated elimination half-life of 140 h. The analytical method described was developed for the determination and quantitation of bromadialone using LC-MS. This method is suitable for the simultaneous identification and quantitation of 10 indirect anticoagulants in human serum, which include five superwarfarins (brodifacoum, bromadiolone, difenacoum, difethialone, and flocoumafen) as rodenticides licenced in Germany and five other vitamin K antagonists (acenocoumarol, coumatetralyl, coumachlor, phenprocoumon, and warfarin). The method is based on an acidic (pH 4.2) liquid-liquid extraction followed by LC-ESI-MS analysis. Analytical separation was carried out using an Atlantis C18 column (2.1 x 20 mm, 3 microm). The mobile phase consisted of methanol/0.1% formic acid; the flow rate was 0.6 mL/min, and the time needed for analysis was 5 min. The lower limit of quantitation was 5 microg/L (signal-to-noise > 10).

Topics: 4-Hydroxycoumarins; Anticoagulants; Chromatography, High Pressure Liquid; Humans; Male; Mass Spectrometry; Middle Aged; Poisoning; Rodenticides; Vitamin K

Topics: Anticoagulants; Combined Modality Therapy; Coumarins; Drug Combinations; Factor IX; Factor VII; Factor X; Hemorrhage; Humans; Male; Middle Aged; Pain; Plasma; Poisoning; Prothrombin; Suicide, Attempted; Vitamin K

Ten dogs underwent clinical monitoring and laboratory investigations following accidental poisoning with anticoabulant rodenticide products. Hematobiochemical parameters, coagulation profiles and toxicologic analyses of plasma and/or tissues were monitored. In 2 cases necropsy examinations were done. The clinical-pathological aspects of anticoagulant rodenticide poisonings of dogs are then discussed.

Topics: Animals; Anticoagulants; Blood Coagulation Disorders; Case-Control Studies; Dog Diseases; Dogs; Partial Thromboplastin Time; Platelet Count; Poisoning; Rodenticides; Vitamin K

To determine usefulness of the test for proteins induced by vitamin K absence or antagonism (PIVKA) to identify anticoagulant-poisoned dogs, compared with one-stage prothrombin time (OSPT) and activated partial thromboplastin time (APTT) tests.. Retrospective study.. 325 dogs.. Comparisons of results of PIVKA, OSPT, and APTT measurements in dogs with anticoagulant poisoning, hepatic disease, disseminated intravascular coagulation, other blood-related disorders, immune-mediated diseases, or other chronic and acute diseases were performed. Median, quartile, and range values were determined.. PIVKA tests with a 150-second critical value had > 98% specificity and > 90% sensitivity for diagnosis of anticoagulant poisoning versus > 99% specificity and > 79% sensitivity with a 300-second critical value. Comparison of PIVKA values among diagnostic groups revealed significant differences between dogs with anticoagulant poisoning and all other groups.. The PIVKA test with a 150-second critical value is diagnostically useful for distinguishing anticoagulant poisoning from other coagulopathies. Severe liver disease can cause false-positive results. Administration of vitamin K1 or early evaluation (within a few hours of ingesting anticoagulant) may cause false-negative results. Dogs with PIVKA test values > 150 seconds and clinical signs of anticoagulant poisoning can confidently be considered to have anticoagulant poisoning because of the high test sensitivity and specificity.

Topics: Animals; Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Factors; Diagnosis, Differential; Dog Diseases; Dogs; False Negative Reactions; False Positive Reactions; Partial Thromboplastin Time; Poisoning; Protein Precursors; Prothrombin Time; Retrospective Studies; Sensitivity and Specificity; Vitamin K

Topics: Acetaminophen; Acetylcysteine; Factor IX; Factor VII Deficiency; Humans; International Normalized Ratio; Liver Function Tests; Poisoning; Prothrombin Time; Time Factors; Vitamin K

Clinical features were evaluated in seven adult cats (six males, one female) with haemorrhage and presumptive anticoagulant rodenticide intoxication. Haemorrhage appeared as thoracic haemorrhage, otic bleeding, haematoma, melena, haematochezia, and petechiation. The most common other presenting signs were lethargy, anorexia, and tachypnoea or dyspnoea. Six cats were anaemic, four cats were mildly thrombocytopenic (58000-161000/ microL), and three had slightly decreased plasma protein or albumin values. The prothrombin time (30.3->100 s, reference range: 16.5-27.5 s) and activated partial thromboplastin time values (32.6->100 s; reference range: 14-25 s) were markedly prolonged in all cats. All cats received vitamin K(1)subcutaneously or orally (3.7-5 mg/kg body weight initially) and depending on severity of signs five cats were transfused with fresh whole blood. Plasma coagulation times improved in all cats and returned to normal in 1-5 days. Rodenticide poisons represent an important but relatively rare cause of haemorrhage in cats and can be effectively treated.

Topics: Administration, Oral; Animals; Anticoagulants; Cat Diseases; Cats; Female; Germany; Hemorrhage; Injections, Subcutaneous; Male; Partial Thromboplastin Time; Poisoning; Prothrombin Time; Radiography; Records; Retrospective Studies; Rodentia; Rodenticides; Vitamin K

Literature sources suggest that iv vitamin K is associated with significant adverse side effects. Systematic study and documentation is lacking. In this 2-y retrospective review, 100 sequential doses of iv administered vitamin K in 45 patients were identified by computer-generated pharmacy utilization reports in an adult teaching hospital. Charts were reviewed for complications following infusion of vitamin K, including specific abnormalities during the 90-min period post-administration: systolic blood pressure <90, heart rate <60 or >120, rash, shortness of breath, and syncope. Complete post-administration data were available for 60/100 doses. One episode of clinically insignificant transient hypotension was identified. Progress notes, discharge summaries and a concurrent survey of adverse drug reaction reports identified no complications related to the use of iv vitamin K. In this series, the iv administration of vitamin K did not pose a clinically significant risk.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Antifibrinolytic Agents; Female; Humans; Hypotension; Injections, Intravenous; Kentucky; Male; Medical Records; Middle Aged; Poisoning; Retrospective Studies; Vitamin K

To examine patients who presented to a hospital emergency department with evidence of warfarin toxicity, and to review the available published literature to determine what guidelines are available for management of this problem.. A retrospective analysis of all adult patients who presented to The Geelong Hospital Emergency Department between 1 January 1996 and 30 June 1998 with international normalized ratio > 6 due to warfarin toxicity.. A total of 84 patients with international normalized ratio > 6 were included in the study. The average age was 68.3 years. Fifty-three per cent were women. The international normalized ratio was between 6 and 10 in 33 patients (39%), and greater than 10 in 51 patients (61%). Major bleeding occurred in 16.7% of patients, minor bleeding in 17.8%. Sixty-five per cent had no bleeding. Seven patients died, four of those with bleeding. Patients with an international normalized ratio > 10 were more likely to receive fresh frozen plasma (77.6% vs 28.6%; P < 0.001) and in greater amounts (3.0 units vs 0.8 units; P < 0.001) than those with an international normalized ratio of 6-10. There were also more episodes of major bleeding, although not significant. Patients with major bleeding were older (mean 75.4 years vs 67.5 years; P = 0.04), more likely to be admitted (P = 0.046), were more often given fresh frozen plasma (P = 0.003) and in greater amounts (3.28 units vs 2.0 units; P = 0.02).. Warfarin toxicity is a common problem, and variation in management is not surprising considering the lack of consensus in the literature on this topic. Current recommendations are summarized and a simple flowchart for management of this problem is provided.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Anticoagulants; Emergency Treatment; Female; Hemorrhage; Humans; Male; Middle Aged; Plasma; Poisoning; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; Victoria; Vitamin K; Warfarin

The plasma concentration, plasma half-life (t1/2), and mean residence time (MRT) of rodenticide anticoagulants were determined in 21 dogs in which a preliminary diagnosis of anticoagulant rodenticide poisoning had been made. Brodifacoum, difethialone, and difenacoum were detected by high-performance liquid chromatography (HPLC) in the plasma of 13, 3, and 2 dogs, respectively. At presentation the plasma concentration ranged from below the detection limit (10 ng/L) to 851 ng/L. Toxin could not be detected in 3 dogs, despite these animals showing characteristic coagulation disturbances and a positive response to therapy with vitamin K1. In 7 dogs the estimated t1/2 of brodifacoum ranged from 0.9 to 4.7 (median 2.4) days with a MRT of 1.9 to 3.7 (median 2.8) days. In 2 dogs the individual t1/2 of difethialone was 2.2 and 3.2 days and the MRT was 2.3 and 2.8 days, respectively. Two dogs died during emergency treatment. Treatment in the remaining 19 dogs consisted of the administration of vitamin K1 and supportive therapy. The dose of vitamin K1 was reduced in a stepwise manner as long as the prothrombin time remained within physiological limits. The variation in initial plasma concentrations of the anticoagulants combined with the results of treatment support the idea that an individual therapeutic approach is warranted.

Topics: Animals; Anticoagulants; Chromatography, High Pressure Liquid; Dog Diseases; Dogs; Half-Life; Partial Thromboplastin Time; Poisoning; Prothrombin Time; Rodenticides; Treatment Outcome; Vitamin K

Superwarfarin sodium exposure or poisoning is a growing public health problem. There were 5133 reported cases of superwarfarin exposure and poisoning in 1988 and 13 423 cases in 1995. Cases may be associated with accidental exposure, suicide attempts, or Munchausen syndrome, and may be difficult to diagnose.. Patients from northern Wisconsin with superwarfarin exposure or poisoning were examined at a tertiary referral center in rural Wisconsin to determine what led to their exposure and to review the clinical manifestations, diagnosis, treatment, and prevention of superwarfarin poisoning.. Eleven cases satisfied the criteria for superwarfarin exposure or poisoning. All 7 children included in the study had accidentally ingested superwarfarin, 2 adults had Munchausen syndrome, and 1 teenager and 1 adult had attempted suicide using superwarfarin. Nine of the 11 cases had taken brodifacoum. The patients who had accidentally ingested superwarfarin or attempted suicide using it were easily diagnosed, while diagnosis was markedly delayed for the 2 patients with Munchausen syndrome. Full reversal of anticoagulation was quickly achieved in the cases of accidental ingestion and attempted suicide. We examined and treated the patients with Munchausen syndrome for months before establishing a diagnosis and fully reversing the anticoagulation. None of the patients in our study died of superwarfarin poisoning.. Superwarfarin exposure or poisoning is a growing public health problem that should be part of the differential diagnosis of patients who present with a coagulopathy consistent with vitamin K deficiency in the absence of coumadin therapy, liver disease, or the use of an inhibitor, and whose conditions do not resolve with large doses of parenteral vitamin K1 therapy.

Topics: 4-Hydroxycoumarins; Adult; Aged; Anticoagulants; Blood Coagulation Disorders; Diagnosis, Differential; Female; Humans; Incidence; Male; Middle Aged; Munchausen Syndrome; Poisoning; Rodenticides; Suicide, Attempted; United States; Vitamin K; Wisconsin

Topics: 4-Hydroxycoumarins; Blood Transfusion; Depressive Disorder; Drug Monitoring; Emergency Treatment; Female; Humans; Middle Aged; Poisoning; Prothrombin Time; Rodenticides; Suicide, Attempted; Vitamin K

Increased popularity during the past decade of brodifacoum, an anticoagulant rodenticide, has led to an increase in cases of accidental poisoning in nontarget species, including pets and farm animals. Pharmacokinetics of second-generation anticoagulant rodenticides such as brodifacoum are substantially different from those of first-generation anticoagulant rodenticides such as warfarin. This difference dramatically influences management of exposure in terms of duration and cost of treatment and may affect outcome. The National Poison Control Center reports that approximately 50 cases of brodifacoum exposure have occurred in horses between 1993 and 1997. To our knowledge, this report is the first complete clinical description of accidental ingestion of a potentially lethal dose of brodifacoum in horses. Early recognition of exposure to brodifacoum, subsequent treatment with adequate doses of vitamin K1, and sequential monitoring of clotting times and serum brodifacoum concentration permitted poisoning in these horses to be managed successfully.

Topics: 4-Hydroxycoumarins; Animals; Anticoagulants; Blood Coagulation; Half-Life; Horse Diseases; Horses; Male; Partial Thromboplastin Time; Poisoning; Prothrombin Time; Rodenticides; United States; Vitamin K

Topics: 4-Hydroxycoumarins; Animals; Diagnosis, Differential; Dog Diseases; Dogs; Female; Hemostatics; Laryngeal Edema; Poisoning; Postoperative Hemorrhage; Rodenticides; Tracheostomy; Vitamin K

Brodifacoum is a 4-hydroxycoumarin derivative that is commonly used as a rodenticide. Human exposures have produced severe coagulopathies resulting in hematuria, gastrointestinal bleeding, intracranial hemorrhage, and death. This is the first report of spontaneous hemoperitoneum secondary to brodifacoum ingestion. The patient was successfully managed with fresh frozen plasma, packed red blood cells, and vitamin K1. No surgical intervention was performed. The patient required ongoing daily vitamin K1 therapy for longer than 6 months.

Topics: 4-Hydroxycoumarins; Adult; Blood Component Transfusion; Drug Overdose; Erythrocyte Transfusion; Female; Hemoperitoneum; Humans; Plasma; Poisoning; Rodenticides; Vitamin K

Prolongation of the prothrombin time owing to a transient reduction in factor VII activity is described in a 14-month-old child with organophosphate poisoning. Correction after vitamin K administration suggested an organophosphate-related effect on vitamin K-dependent factor VII activity. Historically, coagulation screening has not been routinely recommended after organophosphate intoxications. We suggest, however, that routine screening in such patients may be important. A brief review of organophosphate poisoning and the unique features of our case are presented.

Topics: Acetylcholinesterase; Factor VII; Female; Humans; Infant; Organophosphate Poisoning; Poisoning; Prothrombin Time; Vitamin K

Topics: Acenocoumarol; Adult; Drug Overdose; Humans; Male; Poisoning; Vitamin K

A 36-month-old child had spontaneous hemorrhage from her nose, mouth, and urinary tract, and a fall in hemoglobin of 20 gm/L (2 gm/dl). The prothrombin time and partial thromboplastin time were markedly prolonged with a decrease in the vitamin K-dependent factors. The child had ingested brodifacoum, a long-acting rodenticide. Prolonged follow-up and treatment with vitamin K were necessary.

Topics: 4-Hydroxycoumarins; Child, Preschool; Female; Hemorrhage; Humans; Poisoning; Rodenticides; Vitamin K

A Doberman Pinscher was evaluated for acute onset of gastroenteritis, characterized by anorexia, hematemesis, and hematochezia. The dog had ingested mole bait containing thallium 2 days prior to admission. Thallium toxicosis was confirmed by detection of thallium in the urine, using colorimetric analysis. The dog responded well to administration of antibiotics, fluids administered IV, warm-water enemas, and oral administration of activated charcoal slurries.

Topics: Ampicillin; Animals; Charcoal; Chemotherapy, Adjuvant; Colorimetry; Diagnosis, Differential; Dog Diseases; Dogs; Enema; Fluid Therapy; Male; Poisoning; Thallium; Vitamin K

The clinical course of a patient poisoned with the 'superwarfarin' brodifacoum and a method for estimation of plasma levels is described. It was characterised by prolonged depression of Vitamin K-dependent clotting factors poorly responsive to Vitamin K administration.

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Tests; Blood Transfusion; Chromatography, High Pressure Liquid; Humans; Male; Poisoning; Rodenticides; Vitamin K

Topics: Adult; Atropine; Cephalothin; Gastric Lavage; Humans; Hydrocortisone; Insecticides; Male; Obidoxime Chloride; Organothiophosphorus Compounds; Parenteral Nutrition, Total; Poisoning; Respiration, Artificial; Vitamin K

Topics: Blood Transfusion; Emergencies; Exchange Transfusion, Whole Blood; Hemorrhage; Humans; Hypothermia; Infant, Newborn; Infant, Newborn, Diseases; Jaundice, Neonatal; Poisoning; Seizures; Vitamin K; Vitamin K Deficiency Bleeding

Topics: Animals; Blood Transfusion; Dicumarol; Hemorrhage; Poisoning; Swine; Swine Diseases; Vitamin K

Topics: Animals; Poisoning; Swine; Swine Diseases; Vitamin K; Warfarin

Topics: Anemia; Anemia, Hemolytic; Erythrocytes; Glucosephosphate Dehydrogenase Deficiency; Glucosephosphates; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Naphthalenes; Poisoning; Toxicology; Vitamin K

Topics: Chelating Agents; Child; Dimercaprol; Drug Therapy; Edetic Acid; Heavy Metal Poisoning; Humans; Indicators and Reagents; Metals, Heavy; Poisoning; Thallium; Toxicology; Vitamin A; Vitamin K; Vitamins

Topics: Blood Coagulation Tests; Criminals; Diagnosis; Factor IX; Factor VII; Factor X; Geriatrics; Hemorrhagic Disorders; Humans; Poisoning; Prothrombin Time; Toxicology; Vitamin K; Warfarin

Topics: Cyanides; Poisoning; Potassium; Potassium Cyanide; Thioctic Acid; Vitamin A; Vitamin K; Vitamins

Topics: Antifibrinolytic Agents; Aspirin; Heparin Antagonists; Humans; Naphthoquinones; Poisoning; Retinoids; Vitamin K

Topics: Acrolein; Ascorbic Acid; Humans; Inositol; Lung Diseases; Poisoning; Vitamin A; Vitamin E; Vitamin K; Vitamins

Topics: Antifibrinolytic Agents; Coumarins; Dicumarol; Hemorrhage; Naphthoquinones; Poisoning; Retinoids; Vitamin K; Vitamin K 1