Citation

McCulloch KJ, Chen Y, Gau JP, Yang CC, Isoardi KZ. Clin. Toxicol. (Phila) 2023; 61(12): 1059-1060.

Copyright

(Copyright © 2023, Informa - Taylor and Francis Group)

DOI

10.1080/15563650.2023.2286693

PMID

38270056

Abstract

Bromadiolone, a second-generation anticoagulant rodenticide, has a long half-life [Citation1,Citation2]. It is a vitamin K antagonist, inhibiting the synthesis of factors II, VII, IX, X, proteins C, S, and Z [Citation3]. Poisoning causes protracted coagulopathy [Citation3,Citation4], which is reversible with phytomenadione (vitamin K1) [Citation3]. There are limited toxicokinetic data on bromadiolone poisoning. We report a life-threatening case of suspected repeated homicidal bromadiolone poisoning, complicated by concealed poisoning and complications to medical treatment.

A previously well 24-year-old university student, overseas on language exchange, became unwell. Over several weeks, he had multiple emergency department presentations for symptoms, including dizziness, headache, and abdominal pain. He was diagnosed with acute pyelonephritis when he was noted to have haematuria with pyuria. Worsening symptoms and further spontaneous bleeding (epistaxis, ecchymosis, haematuria) prompted a return to the emergency department. Upon first testing, his international normalized ratio was >7.86, and the prothrombin time was >90.0 s. As warfarin-like poisoning was suspected, his coagulopathy was treated with high-dose intravenous phytomenadione and fresh frozen plasma. He developed a rash, fever, pulmonary oedema, and circulatory shock, features which were considered to be either anaphylactoid reactions to phytomenadione or due to fresh frozen plasma-related acute lung injury or sepsis. Over the subsequent 1–2 weeks, blood product transfusion and parenteral phytomenadione were reintroduced multiple times, with variable reactions. His international normalized ratio then fluctuated between 2.3 and 7.8. ...

Language: en