title: An acquired hemorrhagic disorder from long-acting rodenticide ingestion.
abstract: A 62-year-old man who presented with gross hematuria was found to have a severe and prolonged coagulopathy. The workup involved mixing studies, which suggested an acquired factor deficiency, and specific factor assays, which demonstrated isolated defects in vitamin K-dependent factors. With vitamin K deficiency excluded, and serum warfarin levels undetectable, so-called superwarfarin ingestion was suspected. This diagnosis was subsequently proved by biochemical evidence (an increase in the serum vitamin K epoxide-vitamin K ratio) and compatible history. This case illustrates how a logical workup can lead to a diagnosis of superwarfarin ingestion, even without a history of such an ingestion. New serum assays for specific superwarfarins are also mentioned. This case report should increase clinicians' awareness of long-acting rodenticide ingestions.
authors.affiliation: Department of Medicine, Dartmouth Medical School, Hanover, NH.
authors.forename: G S
authors.initials: GS
authors.lastname: Ross
authors.forename: L R
authors.initials: LR
authors.lastname: Zacharski
authors.forename: D
authors.initials: D
authors.lastname: Robert
authors.forename: D L
authors.initials: DL
authors.lastname: Rabin
mesh_terms: D015110:4-Hydroxycoumarins / Q000506:poisoning*; D006474:Hemorrhagic Disorders / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011041:Poisoning / Q000097:blood / Q000150:complications; D011517:Prothrombin Time; D012378:Rodenticides / Q000506:poisoning*; D013997:Time Factors
chemical_list: D015110:4-Hydroxycoumarins; D012378:Rodenticides; C013418:bromfenacoum