Unintentional ingestion of a high dose of acenocoumarol in a young child

Metabolic management of accidental intoxication

PURPOSE OF REVIEW

Unintentional intoxication comprises a major chunk of all intoxications. Most patients are in the pediatric age group with another set of patients being the elderly. Substances found to cause accidental intoxication vary from country to country and even within different regions of a country. Frequent reviews of current literature are needed to be abreast of trends.

RECENT FINDINGS

Prescription drugs and household chemicals are major culprits when it comes to accidental intoxication. Acetaminophen, digoxin and metformin are some of the prominent prescription drugs frequently associated with unintentional intoxications. Increasingly alcohol based hand sanitizers are becoming an important etiology of these events, following their increased usage during the COVID-19 pandemic. Pattern recognition to identify class of intoxicant and supportive care including prevention of further absorption and increased excretion are cornerstones of therapy. Antidote when available should be used promptly.

SUMMARY

Knowledge about current epidemiology of accidental intoxications, toxidrome pattern recognition and appropriate antidote usage beside adequate and timely supportive care help in successful management of the unfortunate victim of accidental intoxication.

Asymptomatic Anticoagulant Rodenticide Exposure in Dogs and Cats—A French and Belgian Rural and Urban Areas Study

Anticoagulant rodenticides (ARs) are important tools for controlling rodent pests, but they also pose a health threat to non-target species. ARs are one of the most common causes of pet poisoning. However, exposure of domestic animals to subclinical doses of ARs is poorly documented. To study the random exposure of dogs and cats to ARs, feces from animals showing no clinical signs of rodenticide poisoning were collected from a network of French and Belgian veterinarians. We analyzed fresh feces from 304 dogs and 289 cats by liquid chromatography-tandem mass spectrometry. This study showed a limited prevalence of AR exposure in dogs and cats of 2.6 and 4.5% respectively. In both species, access to the outdoors is a risk factor for ARs exposure. In contrast, the sex of the animals did not affect the ARs exposure status. The observation of the ratio of cis and trans isomers suggested primary exposure in dogs, but also in some cats. While primary exposure in dogs appears to be related to the use of ARs as plant protection products, primary exposure in cats may be malicious, as warfarin, an anticoagulant formerly used as a rodenticide and now used only in humans, was found in 4 of 13 exposed cats. Secondary exposure may also occur in cats.Our study showed reduced exposure in dogs and cats, compared to wildlife, which often has high exposure, especially in areas where rodent control is important.

Development of a Fluorescent Microfluidic Device Based on Antibody Microarray Read-Out for Therapeutic Drug Monitoring of Acenocoumarol

The development of a proof-of-concept point-of-care (PoC) device for the determination of oral anticoagulants determination is presented. Acenocoumarol (ACL) is prescribed to prevent certain cardiovascular diseases related to the prevention of deep vein thrombosis, pulmonary embolism, myocardial infarction, and stroke. Oral anticoagualant treatment (OAT) represents a population of 2% under treatment which has expenditures about $ 144 million in 2011. The main drawback for OAT is the associated narrow therapeutic window and the unpredictable dose-response relationship, which is one of the main causes for visiting the emergency room at the hospitals. In a previous work, family antibodies were produced for the simultaneous detection of ACL and warfarin (W) depending on the area of application. It was developed in different formats, indirect and direct, either with similar detectabilities and both assays quantifying the oral anticoagulants with high accuracy and reproducibility. We present the implementation of the already developed immunochemical method to a point-of-care (PoC) device to assist on the patient compliance assessment programs. In order to achieve this goal, a first development was performed implementing ACL ELISA assay into a microarray format with fluorescent read-out. The assay was successfully implemented achieving a LOD of 1.23 nM of ACL directly measured in human plasma. Then, a fully integrated microfluidic system is developed which incorporates the specific immunoreagents for the detection of ACL. The immunoreagents were attached onto the glass slide in a microarray format. The system is automatic, rapid, sensitive, and disposable that could help clinicians monitor patients under OAT. According to the fluorescent label of the ACL binding, the chip can be easily read with a scanner. The microfluidic system performed good according to the robust and reproducible signals, and subsequently yielded an accurate result.