RESUMO
La intoxicación humana por rodenticidas anticoagulantes de acción prolongada, conocidos como superwarfarinas, provoca coagulopatía de prolongado manejo. Presentamos el caso de un hombre de 42 años que ingirió una dosis tóxica de rodenticida en un intento suicida, evolucionando con epistaxis, INR de 11,6 y necesidad de hospitalización. Durante 7 días se realizaron controles seriados de pruebas de coagulación, con optimización de diferentes dosis de suplementación de Vitamina K. El caso destaca la potencia y vida media prolongada (aproximadamente 6 semanas) de este tipo de anticoagulantes, hecho que requiere un control clínico regular y una adherencia al tratamiento satisfactoria.
Human intoxication by long-acting anticoagulant rodenticides, known as superwarfarins, causes coagulopathy that is difficult to manage. We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, evolving with epistaxis, INR of 11.6, and needing hospitalization. For seven days, serial controls of coagulation tests were carried out, with optimization of different doses of Vitamin K supplementation. The case highlights this type of anticoagulant's potency and prolonged half-life (approximately six weeks), which requires regular clinical control and satisfactory treatment adherence.
Assuntos
Humanos , Masculino , Adulto , Rodenticidas/intoxicação , Tentativa de Suicídio , Anticoagulantes/intoxicação , Vitamina K/uso terapêutico , 4-Hidroxicumarinas/intoxicaçãoRESUMO
Human intoxication by long-acting anticoagulant rodenticides, known as superwarfarins, causes coagulopathy that is difficult to manage. We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, evolving with epistaxis, INR of 11.6, and needing hospitalization. For seven days, serial controls of coagulation tests were carried out, with optimization of different doses of Vitamin K supplementation. The case highlights this type of anticoagulant's potency and prolonged half-life (approximately six weeks), which requires regular clinical control and satisfactory treatment adherence.
Assuntos
Anticoagulantes , Rodenticidas , Tentativa de Suicídio , Humanos , Masculino , Adulto , Rodenticidas/intoxicação , Anticoagulantes/intoxicação , 4-Hidroxicumarinas/intoxicação , Vitamina K/uso terapêuticoRESUMO
The case of a 46-year-old woman who survived after a brodifacoum poisoning is presented. The patient was admitted due to a severe coagulopathy. Initial prothrombin time and activated partial thromboplastin time were both greater than 110 seconds and the patient suffered severe gastric and pulmonary hemorrhage requiring fresh frozen plasma transfusion and parenteral phytonadione administration (up to 100 mg per day). Serum brodifacoum levels were determined by HPLC during seven months. Five days after admission, serum brodifacoum level was 1302 ng/ml. Serum brodifacoum levels decreased till day 209 when became not detectable. Brodifacoum elimination showed a first order kinetic and a 56-day half-life. Investigation of superwarfarin should be considered in any patient with vitamin K dependent coagulation disorder. It would be also useful to obtain periodic brodifacoum levels and build the corresponding elimination curve to help direct phytonadione therapy in poisoned patients.
Assuntos
4-Hidroxicumarinas/intoxicação , Anticoagulantes/intoxicação , Rodenticidas/intoxicação , 4-Hidroxicumarinas/sangue , 4-Hidroxicumarinas/farmacocinética , Anticoagulantes/sangue , Anticoagulantes/farmacocinética , Feminino , Hemorragia/sangue , Hemorragia/induzido quimicamente , Humanos , Pneumopatias/sangue , Pneumopatias/induzido quimicamente , Pessoa de Meia-Idade , Tempo de Protrombina , Rodenticidas/sangue , Rodenticidas/farmacocinética , Gastropatias/sangue , Gastropatias/induzido quimicamente , Tentativa de SuicídioRESUMO
We report a 22 years old male, admitted to the emergency room due to a life threatening coagulation disorder, with prothrombin times fluctuation between 5 and 37% and very low activity of factors II, VII, IX and X. In the month prior to the admission, the patient had used the rodenticide difethialone, without any precaution to avoid accidental exposure. The patient was maintained with fresh frozen plasma until oral vitamin K1 was obtained. This medication corrected the coagulation disorder.
Assuntos
4-Hidroxicumarinas/intoxicação , Anticoagulantes/intoxicação , Transtornos da Coagulação Sanguínea/induzido quimicamente , Rodenticidas/intoxicação , Administração Oral , Adulto , Antifibrinolíticos/administração & dosagem , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Humanos , Masculino , Vitamina K 1/administração & dosagemRESUMO
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.