Convulsive status epilepticus as the initial presentation of superwarfarin poisoning: a case report

Abstract

Bromadiolone, a widely-used rodent control drug, could act as a long-acting anticoagulant.Patients of bromadiolone poisoning often present with multiorgan hemorrhage. However, neurological symptoms of bromadiolone poisoning are seldom reported. We report a rare case with convulsive status epilepticus as the initial presentation of bromadiolone poisoning. A previously healthy 18-year-old man presented with persistent unconsciousness and repeated convulsive seizures. Magnetic resonance imaging revealed lesions in the corpus callosum. Laboratory test revealed the microscopic hematuria, prolonged prothrombin time, prolonged activated partial thromboplastin time and the presence of bromadiolone.The patient was diagnosed as the bromadiolone poisoning and treated with hemofiltration, vitamin K and prothrombin complex. Consciousness of the patient was regained and all neurological symptoms diminished after 7 days. Coagulopathy was totally corrected after 3 weeks, and a 2-month regimen of vitamin K supplementation was prescribed after discharge. Our case suggests that bromadiolone poisoning may involve the central nervous system. The atypical and initial symptoms of neurological disorders might lead to misdiagnosis of bromadiolone poisoning. Poisoning should be considered when acute neurological symptoms are combined with bleeding tendency. The vitamin K treatment is effective for both coagulopathy and central nervous system disorders in bromadiolone poisoning.

Intoksikasi Superwarfarin dengan Ensefalopati Toksik dan Gagal Ginjal Akut pada Anak : sebuah laporan kasus

“…Morbiditas dan mortalitas yang signifikan dari superwarfarin dapat dikontraskan dengan sifat keracunan superwarfarin yang sangat dapat diobati dengan penggantian faktor dan terapi vitamin K, yang tersedia di sebagian besar dunia. (Jia et al, 2021;Wang et al, 2017)…”

“…Hemofiltrasi intermiten dapat menghilangkan bromadiolone untuk menghindari akumulasi serius pada sistem saraf pusat. Dalam kasus kami, gejala sistem saraf pusat dan koagulopati membaik setelah pengobatan vitamin K1 (phytonadione) serta diberikan N(2)-L-alanyl-Lglutamine sebagai nutrisi saraf pusat yang terkena dampak toksisitas (Jia et al, 2021;Wang et al, 2017).…”