Human bromethalin exposures reported to a U.S. Statewide Poison Control System

Huntington, Serena; Fenik, Yelena; Vohra, Rais; Geller, Richard J.

doi:10.3109/15563650.2016.1139713

Cited by 10 publications

(9 citation statements)

References 13 publications

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“…Our literature search identified nine reports of 10 cases of PHB withdrawal (Table 1) [3,10,11,13,[15][16][17][18][19]. In addition, there were five abstracts presented at meetings reporting 12 additional cases (Table 1) [8,[20][21][22][23].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Physical symptoms of acute intoxication can include depressed respiratory drive, altered consciousness, temperature dysregulation, and alterations in hemodynamics including hyper/hypotension and tachycardia [7,8,[10][11][12]15,16,20,[24][25][26][27]. Paradoxically, symptoms can include psychomotor agitation, hallucinations, seizures, and delirium [7,8,[10][11][12]15,16,20,[24][25][26][27]. There are three reports where PHB intoxication was so severe that patients required intravenous sedation to the point where they required tracheal intubation and mechanical ventilation [25,27].…”

Section: Phb Toxicitymentioning

confidence: 99%

“…Management of intoxication is largely supportive with focus on respiratory drive, airway protection, and providing sedation if paradoxical agitation, seizures and delirium are present [7,8,[10][11][12]15,16,20,[24][25][26][27]. PHB is minimally metabolized in the liver and secreted largely unchanged in the urine, according to animal models.…”

Section: Treatment Of Phb Intoxicationmentioning

confidence: 99%

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Acute phenibut withdrawal: A comprehensive literature review and illustrative case report

Hardman

Šprung

Weingarten

2018

Bosn J of Basic Med Sci

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Phenibut is a glutamic acid derivative with activity on the γ-aminobutyric acid (GABA)B, A, and B-phenethylamine receptors. It is prescribed in former Communist Bloc countries for anxiolysis and related psychiatric disorders. It can be easily obtained in Western countries and is thought to have abuse potential. Abrupt discontinuation has been reported to precipitate an abstinence syndrome. A review of the literature identified 22 reported cases, many of which were notable for severe psychomotor agitation and requirements for aggressive pharmacologic treatment. Neurologic and autonomic signs and symptoms may mimic serotonin or neuroleptic malignant syndrome. Patients were typically younger and had coexisting substance abuse disorders to other drugs. Also presented is a case of a 23-year-old male with an acute phenibut abstinence syndrome. This patient exhibited severe psychomotor agitation requiring physical restraints, dexmedetomidine, lorazepam, haloperidol, diphenhydramine, cyproheptadine, melatonin, olanzapine, and baclofen for symptom control.

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Section: Review Of the Literaturementioning

confidence: 99%

Section: Phb Toxicitymentioning

confidence: 99%

Section: Treatment Of Phb Intoxicationmentioning

confidence: 99%

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Acute phenibut withdrawal: A comprehensive literature review and illustrative case report

Hardman

Šprung

Weingarten

2018

Bosn J of Basic Med Sci

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“…In the analysis, 126 calls were included, 113 patient (89.68%) had no effect and only 10 (7.93%) had a minor effect, the majority of which were self-limited gastrointestinal effects. The majority of these exposures were also in children less than 5 years old and reported doses ingested ranged from 0.067 mg/kg up to 0.3 mg/kg [10].…”

Section: Discussionmentioning

confidence: 99%

Medical outcomes of bromethalin rodenticide exposures reported to US poison centers after federal restriction of anticoagulants

Feldman

Stanton

Borys

et al. 2019

Clinical Toxicology

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Background: Exposures to bromethalin rodenticides have increased since restrictions were placed on long acting anticoagulant rodenticide (LAAR) registrations in 2008. Bromethalin works, in part, by uncoupling mitochondrial oxidative phosphorylation. Toxicity in humans is not well characterized and no antidote is available. Methods: This retrospective observational study analyzed data from the National Poison Data System (NPDS). The data set was derived from single substance bromethalin ingestions followed to a known medical outcome that were reported to US poison centers from 01/01/2008 to 12/31/2017. Results: There were 2674 bromethalin exposures in the NPDS database that met inclusion criteria. Of these exposures 2227 (83.28%) were pediatric, aged 16 days-12 years. Within this population, no effects were seen in 2143 (96.38%) of the exposures, 74 (3.32%) had minor effects, and 10 (0.45%) had moderate effects. No major clinical effects or deaths occurred in pediatric patients, although one patient with a major effect was of unknown age. Exposures in patients >12 years encompassed 391 patients aged 13-94 years. No effect was seen amongst 257 (65.73%) of the patients, 100 (25.58%) had minor effects, 23 (5.88%) had moderate effects, nine (2.30%) had major effects, and two (0.51%) patients died. Intentional ingestions among these patients accounted for one (0.25%) death and four (1.02%) major effects. Case details of the intentional ingestion death suggest the possibility of a miscoded long acting coagulant rodenticide. Conclusions: No major effects or deaths were seen in pediatric exposures. A majority of the possible bromethalin exposures involving adults reported to poison centers resulted in minor or no effects, though seizures, death and one questionable case of coagulopathy were documented. This dataset suffers from its retrospective nature, reliance on caller information, selection bias, information bias, and miscoding. It is possible that one or both deaths attributed to bromethalin exposure were not actually due to bromethalin.

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“…The use of rodenticides has evolved with the ages from heavy metals to anticoagulants and neuro-toxic drugs such as bromethalin that acts via the Central nervous system (CNS). 6 Anticoagulants can also be classified into the first (the chronic) and the single dosed (second generation) drugs. Acting via the blockade of the Vitamin K cycle leading to the non-availability of essential clotting factors such as the factors II and VII.…”

Section: Introductionmentioning

confidence: 99%

Psychosis and Rodenticides: A Case Report

Tsundue¹,

Moudgil²

2018

JYP

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Objective: A poison can be any substance that can be taken through any means with net production of toxicity, which may result into death and coma as well. The evolution of rodenticides through history, witnesses the large-scale use of the first and the second-generation rodenticides those are commonly found with many of the household items meant for pest control. Psychosis is a mental health issue associated with episodes of hallucinations and delusions. This leads to the patient's misinterpretation of the surrounding environment. Few literatures have been reported regarding the use of rodenticides in psychotic patients. Manifestations of rodenticide poisoning includes gastric irritations, flank pain, gastric distension etc. The management focus of rodenticide poisoning should be more prominently based on most recent updated guidelines and dose titration should be monitored on the laboratory outcomes. Monitoring is the key to remission.

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Human bromethalin exposures reported to a U.S. Statewide Poison Control System

Abstract: Accidental bromethalin exposures in children appear to be self-limited in toxicity. Additional studies are warranted to determine whether more severe effects are precipitated when larger amounts are involved, particularly in suicidal ingestion.

Cited by 10 publications

References 13 publications

Acute phenibut withdrawal: A comprehensive literature review and illustrative case report

Acute phenibut withdrawal: A comprehensive literature review and illustrative case report

Medical outcomes of bromethalin rodenticide exposures reported to US poison centers after federal restriction of anticoagulants

Psychosis and Rodenticides: A Case Report

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