Retrospective Study of the Characteristics of Anticoagulant-Type Rodenticide Poisoning in Hong Kong

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

BACKGROUND

In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.

METHODS

This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed.

RESULTS

Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%).

CONCLUSION

The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

Outcome of Rodenticide Poisoning and Its Associated Factors Among Adult Patients Admitted with Rodenticide Poisoning at the Emergency Unit of Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, North Central Ethiopia

Introduction

Rodenticides are pesticides used to eradicate rodents. It is a common reason for visits to the emergency department and hospitalization, and it is a major public health concern. Intentional or unintentional intoxication can result in severe consequences with a high fatality rate. In Ethiopia, studies on the outcome of rodenticide poisoning are scarce. The goal of this study was to assess the outcomes of rodenticide poisoning and its associated factors in adult patients admitted to the emergency unit of Debre Tabor Comprehensive Specialized Hospital in North Central Ethiopia.

Methods

A retrospective record review institutional-based cross-sectional study design was used on 156 adult patients treated with rodenticide poisoning at Debre Tabor Comprehensive Specialized Hospital's emergency unit between May 1, 2017 and April 30, 2022. To collect data from patient medical documents and the Health Management Information System, an abstraction sheet was employed. The information was entered into EPI data version 4.6, then exported and analyzed using STATA version 14 software. To analyze the relationship between the dependent and independent variables, bivariable and multivariable regression were used.

Results

A total of 156 participants were involved in the study. The majority of them 55.13% were in the age group of 19-37 years with the median age of 23 years. Three-fourth of the cases were suicidal poisoning. Overall, 49.35% patients presented to Debre Tabor Specialized Hospital had poor outcome. Having suicidal poisoning (AOR = 10.64; 95% CI: 2.43, 46.53), having tachycardia (AOR = 5.41; 95% CI: 1.54, 18.98), being referred from other health center (AOR = 5.78; 95% CI: 1.97, 16.95) were factors associated with poor outcome.

Conclusion

Rodenticide poisoning had a poor overall outcome. Suicidal poisoning, tachycardia, and referral from other health facilities were all important predictors in poor rodenticide poisoning outcomes.

Persistent Coagulopathy After Synthetic Cannabinoid Use

Synthetic cannabinoids (SCs) are chemical compounds created and manufactured, without quality control standards or requirements, to mimic tetrahydrocannabinol (THC). They are widely available in the USA, and they are sold under various brand names, including "K2" and "spice." Many adverse effects have been attributed to SCs, but most recently, they have also been associated with bleeding. There have been reported cases around the globe of SCs contaminated with long-acting anticoagulant rodenticide (LAAR) or superwarfarins. They are developed from compounds such as bromethalin, brodifacoum (BDF), and dicoumarol. LAAR exhibits their mechanism as a vitamin K antagonist inhibiting vitamin K 2,3-epoxide reductase, preventing activation of vitamin K1 (phytonadione). Therefore, reducing the activation of clotting factors II, VII, IX, and X and proteins C and S. In contrast to warfarin, BDF has an extremely long-acting biological half-life of 90 days due to minimal metabolism and limited clearance. Here, we report a 45-year-old male who presented to the emergency room with a 12-day history of gross hematuria and mucosal bleeding without previous history of coagulopathy and recurrent SCs use.

Superwarfarin poisoning: challenges still remain

Superwarfarin (long-acting anticoagulant rodenticide) poisoning should be suspected in unexplained bleeding with prolonged prothrombin time, especially in the absence of another explanation. Diagnosis and treatment of this intoxication remain a challenge as the direct analysis of superwarfarin in serum is not always possible. Therefore, toxin bioavailability remains unknown and close monitoring and treatment for long periods are required to avoid serious bleeding complications. Here, we discuss a case of suspected superwarfarin poisoning to highlight the challenges in early diagnosis and the challenges we encountered in treatment management and ensuring compliance for long periods.

Reversible leukoencephalopathy caused by 2 rodenticides bromadiolone and fluoroacetamide: A case report and literature review

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.

Disseminated Intravascular Coagulopathy Secondary to Unintentional Brodifacoum Poisoning via Synthetic Marijuana

Recent evidence demonstrates a rising epidemic of unintentional brodifacoum poisoning associated with synthetic cannabinoid use. Synthetic cannabinoid use is on the rise because of its inexpensiveness as well as difficulty to screen and regulate. We present a rare case of severe coagulopathy and cardiac arrest secondary to synthetic cannabinoid use complicated by brodifacoum toxicity.

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

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 straightforward 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 4-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.