title: Rodenticide-induced coagulopathy in a young child. A case of Munchausen syndrome by proxy.
abstract: OBJECTIVE
  To present the diagnosis and management of superwarfarin ingestion, a cause of serious and prolonged coagulopathy.
  
  
  METHODS
  Specific identification of the anticoagulant was made by high-pressure liquid chromatography.
  
  
  RESULTS
  A 24 month-old child developed bruises and a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) after receiving multiple doses of brodifacoum, a superwarfarin rodenticide. The coagulopathy was treated successfully with large doses of parenteral and oral vitamin K1; fresh frozen plasma was administered as a precautionary measure on two occasions. After the first 10 days of the child's hospitalization, the mother was identified as the source of brodifacoum, exemplifying the behavior described as Munchausen syndrome by proxy. Oral vitamin K1 was initiated and continued in an outpatient setting with tapering doses over nine months, using the PT as a guide for therapy.
  
  
  CONCLUSIONS
  This report emphasizes the necessity of recognizing rodenticide poisoning and investigating its source. Frequent monitoring of the PT is essential to prevent hemorrhagic complications due to repeat exposure, inadequate vitamin K1 therapy, or noncompliance.
authors.affiliation: Department of Pediatrics, Walter Reed Army Medical Center, Washington, D.C. 20307-5100.
authors.forename: J
authors.initials: J
authors.lastname: Babcock
authors.forename: K
authors.initials: K
authors.lastname: Hartman
authors.forename: A
authors.initials: A
authors.lastname: Pedersen
authors.forename: M
authors.initials: M
authors.lastname: Murphy
authors.forename: B
authors.initials: B
authors.lastname: Alving
mesh_terms: D015110:4-Hydroxycoumarins / Q000097:blood / Q000506:poisoning*; D000328:Adult; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D002649:Child Abuse; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D003131:Combined Modality Therapy; D004438:Ecchymosis / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D016735:Munchausen Syndrome by Proxy / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D010949:Plasma; D010837:Vitamin K 1 / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D015110:4-Hydroxycoumarins; D001779:Blood Coagulation Factors; D010837:Vitamin K 1; C013418:bromfenacoum