Treatment of a long-acting anticoagulant rodenticide poisoning cohort with vitamin K1 during the maintenance period

Long, Jianhai; Peng, Xiaobo; Luo, Yuan; Sun, Yi; Lin, Guo-Dong; Wang, Yongan; Qiu, Zewu

doi:10.1097/md.0000000000005461

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…[ 21 – 24 ] A study of 56 patients with anticoagulant rodenticides poisoning showed that there was not a significant dose–effect relationship between the concentration of rodenticides and the requirement of vitamin K1 during the maintenance period. [ 10 ] For severe cases, transfusion of fresh frozen plasma, prothrombin complex, and/or recombinant coagulation factor VIIa should be given. Muscle injection of acetamide is the targeted treatment for fluoroacetamide, [ 16 ] and calcium therapy can ameliorate cardiac arrhythmias induced by fluoroacetamide.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 , 9 ] Interfering with blood coagulation, bromadiolone induces varying degrees of hemorrhage, such as ecchymoses, gingival bleeding, epistaxis, gastrointestinal bleeding, hematuria, vaginal bleeding, and rarely SAH. [ 6 , 10 – 14 ] Besides coagulopathy, patients with bromadiolone poisoning sometimes present with headache, seizure, hallucinations, dizziness, consciousness impairment and a few other symptoms of central nervous system (CNS). [ 7 ] Fluoroacetamide poisoning often causes damages in heart (QT prolongation, arrhythmia, myocardial damage), digestive system (vomiting, nausea, burning sensation in the epigastrium), and CNS (seizure, aphasia, myasthenia, and coma).…”

Section: Introductionmentioning

confidence: 99%

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Reversible leukoencephalopathy caused by 2 rodenticides bromadiolone and fluroacetamide

Yuan²,

Yao³

et al. 2021

Medicine

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Rationale: With the easy access, rodenticide poisoning has been a public health problem in many countries. Characteristics of central nervous system (CNS) lesions induced by rodenticides are scarcely reported. Patient concerns: We presented a case of a 40-year-old man with seizure and consciousness disorder, coagulation dysfunction, and symmetric lesions in white matter and corpus callosum. Diagnosis: He was diagnosed with rodenticide poisoning due to bromadiolone and fluoroacetamide. Interventions: He was treated with vitamin K, hemoperfusion, acetamide, and calcium gluconate. Outcomes: His leukoencephalopathy was reversed rapidly with the improvement of clinical symptoms. Lessons: This report presented the impact of rodenticide poisoning on CNS and the dynamic changes of brain lesions, and highlighted the importance of timely targeted treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reversible leukoencephalopathy caused by 2 rodenticides bromadiolone and fluroacetamide

Yuan²,

Yao³

et al. 2021

Medicine

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“…Rice is usually washed with water before cooking, and the concentration of leftover bromadiolone in a rice meal might be less than 0.005%. Bromadiolone is thermally stable below 200 degrees Celsius [ 7 ]. In cases without washing, a bowl of rice is calculated to contain 9 mg of rat poison.…”

Section: Discussionmentioning

confidence: 99%

“…These findings seemed to not be applicable in these cases of low-dose and repeated LAAR exposure. The patients who suffered from significant bleeding and abnormal INR values required the use of vitamin K1 therapy even with serum bromadiolone level less than 4 ng/mL [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Rat Bait, Not Healthy Rice!

Lee

Lin²,

Chu³

et al. 2023

Toxics

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Bromadiolone, a potent, long-acting anticoagulant rodenticide is frequently tinted to a red or pink color and mixed with cereals as rat bait. Six peoples working in a small factory suffered from a severe bleeding tendency several weeks after consuming a rice meal that was tainted with bromadiolone mistaken to be healthy food. High serum levels of bromadiolone and excessive bleeding were found in these individuals, and they needed vitamin K1 therapy for weeks. These cases indicated that long-acting anticoagulant rodenticide might induce cumulative toxicity in repeated, low-dose exposure, and the blood levels of bromadiolone might be an indicator for antidote therapy if available.

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“…Many clinicians have experience with the treatment of supratherapeutic INRs; however, LAAR poisoning requires high-dose and long-term vitamin K treatment, as the half-life of LAAR is between 10 and 70 days, which is 10–50 times longer than the half-life of warfarin 2. For patients with active bleeding, the first-line haemostatic therapy is FFP and haemostatic dosing of vitamin K 1 (phytonadione) 8. Vitamin K 1 dosing is titrated to response based on monitoring coagulation assay values (PT/INR) and refractory bleeding, with the median duration of vitamin K 1 treatment reported as 140 days.…”

Section: Discussionmentioning

confidence: 99%

Deliberate self-poisoning with long-acting anticoagulant rodenticides

Reimer¹,

Smith

Ali

2017

BMJ Case Reports

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Long-acting anticoagulant rodenticides, also called superwarfarins, are known for their greater potency, longer half-life and delayed onset of symptoms. Cases of superwarfarin poisoning can pose a diagnostic and clinical challenge due to a wide array of presentations and prolonged severe coagulopathy requiring months of high-dose oral vitamin K therapy. The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. We discuss a case of deliberate self-poisoning with long-acting anticoagulant rodenticides presenting with haematuria and coagulation values above measurable limits. This case is important as it required immediate and maintenance therapy in order to prevent profound bleeding, as well as the evaluation of the patient's psychosocial factors to ensure medical compliance and to prevent refractory complications or repeated self-harm.

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Treatment of a long-acting anticoagulant rodenticide poisoning cohort with vitamin K1 during the maintenance period

Abstract: Supplemental Digital Content is available in the text

Cited by 8 publications

References 21 publications

Reversible leukoencephalopathy caused by 2 rodenticides bromadiolone and fluroacetamide

Reversible leukoencephalopathy caused by 2 rodenticides bromadiolone and fluroacetamide

Rat Bait, Not Healthy Rice!

Deliberate self-poisoning with long-acting anticoagulant rodenticides

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