An Outbreak of Brodifacoum Coagulopathy Due to Synthetic Marijuana in Central Illinois

Hussain, Nooreen; Hussain, Faiz; Haque, Danish; Saeed, Sarah O. M.; Jesudas, Rohith

doi:10.1016/j.mayocp.2018.05.005

Cited by 16 publications

(15 citation statements)

References 2 publications

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“…45 In the recent outbreak of synthetic cannabinoid-associated superwarfarin poisoning, patients were treated with vitamin K1 in doses of 100 mg/day, resulting in a monthly drug cost of US$24,000-37,000 per patient although these initially cited prices may be an overestimate due to short-term shortage of drug. 16,[105][106][107][108] Such high cost of vitamin K was not seen in Hong Kong, and is not the case for example with the UK. 109 Currently, there are no established guidelines for termination of vitamin K1 therapy in patients with known superwarfarin poisoning.…”

Section: Treatment For Superwarfarin Poisoningmentioning

confidence: 99%

Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management

Chong

Mak

2019

CBR

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Superwarfarins are long-acting anticoagulant rodenticides developed from warfarin. The mechanism of action is by inhibition of vitamin K epoxide reductase, resulting in the inability of the body to recycle vitamin K. Deficiency of vitamin K thereafter leads to inability for the body to synthesise vitamin K-dependent coagulation factors, factor II, VII, IX, and X, leading to prolonged prothrombin time. Due to the bulky aromatic sidechains, superwarfarins have a much longer half-life when compared to warfarin, and exposure to superwarfarins results in a prolonged period of anticoagulation which can result in clinical bleeding. Diagnosis is straight forward in patients with known history of superwarfarin exposure but has proved difficult for patients who did not report superwarfarin intake. Superwarfarin poisoning should therefore be suspected in all patients with unexplained prolongation of prothrombin time, and can be confirmed by their detection in serum. Treatment for superwarfarin poisoning includes rapid correction of factor deficiencies with either four factor prothrombin complex concentrate or fresh frozen plasma in patients with active bleeding, and high dose vitamin K therapy given multiple times per day for a prolonged period of weeks to months.

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Section: Treatment For Superwarfarin Poisoningmentioning

confidence: 99%

Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management

Chong

Mak

2019

CBR

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“…Inhalation of brodifacoum leading to haemorrhage (mainly haematuria) has been observed in the USA following a spate of laced synthetic marijuana products 9. In this case, our patient was a never-smoker with no exposure to such products; however, these US case reports do demonstrate that due to circumspect histories, identifying inhalation of brodifacoum as a cause for haemoptysis is challenging 10…”

Section: Discussionmentioning

confidence: 80%

Unusual presentation of haemoptysis following accidental inhalation of the ‘superwarfarin’ rodenticide brodifacoum

2019

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Haemoptysis is a worrying symptom for patients and can represent a diagnostic challenge for clinicians. We present the case of a 56-year-old woman who presented to the emergency department with acute haemoptysis and associated sudden-onset dyspnoea. The patient remained haemodynamically stable and there was no demonstrable drop in haemoglobin concentration. Following rigorous investigations, on further questioning, the patient recalled inadvertent inhalation of the rodenticide brodifacoum. This exposure was deemed to represent the cause of their acute haemoptysis, which subsequently fully resolved without intervention.

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“…Clinical specimens from 81 subjects with probable or confirmed cases tested positive for brodifacoum, which is used in rodenticides as a long-acting vitamin K antagonist 25. Three case reports were published after the outbreak describing coagulopathy related to K2 tainted with brodifacoum; additional information on these cases26,27 can be found in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Review of the many faces of synthetic cannabinoid toxicities

Alipour¹,

Patel

Shabbir

et al. 2019

Mental Health Clinician

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Introduction Synthetic cannabinoids (SCs) are psychoactive substances that are gaining popularity for their availability and lack of detection by standardized drug tests. Although some users may perceive SCs as safer alternatives to marijuana, some SCs are more potent and result in more severe toxicities. Methods A search of the literature was conducted in the PubMed and SciFinder databases. Results in PubMed were limited to human studies, and only articles in English were included. Results Review of the literature illustrates the hazards associated with SC use. A range of severe toxicities affecting numerous systems has been identified, such as arrhythmias, myocardial infarction, sudden cardiac death, psychosis, suicidal ideation, seizures, acute tubular necrosis, and intracranial hemorrhage. Additionally, a recent outbreak of coagulopathies and at least 4 associated deaths due to SCs tainted with brodifacoum have been reported. Discussion Synthetic cannabinoids may be perceived as a safer alternative to marijuana; however, SCs can be more potent at the cannabinoid receptors and in turn have greater toxicities. Limited information is available on the metabolism of SCs; however, cytochrome P450 pathways may be involved, which could result in drug interactions and unpredicted adverse effects. Toxicity with SC use is not just related to its effects, but also to additives that may taint these products and enhance their effects. Health care providers should be aware of the range of toxicities related to SC use, and tainted products such as these agents are not detected on routine drug screens.

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An Outbreak of Brodifacoum Coagulopathy Due to Synthetic Marijuana in Central Illinois

Cited by 16 publications

References 2 publications

Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management

Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management

Unusual presentation of haemoptysis following accidental inhalation of the ‘superwarfarin’ rodenticide brodifacoum

Review of the many faces of synthetic cannabinoid toxicities

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