Case management and plasma half-life in a case of brodifacoum poisoning.
Brodifacoum is a readily available, second-generation anticoagulant rodenticide (superwarfarin) that causes extended depletion of vitamin K1-dependent clotting factors. Brodifacoum ingestions are being reported with increasing frequency. For the first time, we compare plasma brodifacoum concentration to prothrombin levels over time in a case of brodifacoum poisoning. Brodifacoum was eliminated according to a two-compartment model, with an initial half-life of 0.75 days and a terminal half-life of 24.2 days. On admission, the brodifacoum level was 731 micrograms/L and the patient suffered severe urinary tract hemorrhage, requiring transfusion of blood products. Persistently increased prothrombin times necessitated treatment with phytonadione up to 80 mg/d for 4 months, until the brodifacoum level reached 10 micrograms/L. These data may help project the duration of phytonadione treatment required in future cases of brodifacoum poisoning. Superwarfarin exposure must be suspected in an otherwise unexplained vitamin K1-deficient coagulopathy.
Hollinger
B R
BR
Department of Internal Medicine, University of North Carolina Hospitals, Chapel Hill.
Pastoor
T P
TP
D015110:4-Hydroxycoumarins / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D000328:Adult; D001803:Blood Transfusion; D006207:Half-Life; D006801:Humans; D008297:Male; D011041:Poisoning / Q000628:therapy; D011517:Prothrombin Time; D012378:Rodenticides / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D010837:Vitamin K 1 / Q000627:therapeutic use
D015110:4-Hydroxycoumarins; D012378:Rodenticides; D010837:Vitamin K 1; C013418:bromfenacoum