title: Acute bromadiolone intoxication.
abstract: A 55-year-old man came to the hospital with a bleeding wound on his tongue. The coating of his tongue was green, and his sputum was red. Because an increased international normalized ratio-value was measured, a blood sample was sent to our laboratory with the suspicion of coumarin intoxication. Liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) analysis confirmed the poisoning was by bromadiolone, with its maximum serum concentration at 440 microg/L. The analysis of further samples resulted in a calculated elimination half-life of 140 h. The analytical method described was developed for the determination and quantitation of bromadialone using LC-MS. This method is suitable for the simultaneous identification and quantitation of 10 indirect anticoagulants in human serum, which include five superwarfarins (brodifacoum, bromadiolone, difenacoum, difethialone, and flocoumafen) as rodenticides licenced in Germany and five other vitamin K antagonists (acenocoumarol, coumatetralyl, coumachlor, phenprocoumon, and warfarin). The method is based on an acidic (pH 4.2) liquid-liquid extraction followed by LC-ESI-MS analysis. Analytical separation was carried out using an Atlantis C18 column (2.1 x 20 mm, 3 microm). The mobile phase consisted of methanol/0.1% formic acid; the flow rate was 0.6 mL/min, and the time needed for analysis was 5 min. The lower limit of quantitation was 5 microg/L (signal-to-noise > 10).
authors.affiliation: Berliner Betrieb für Zentrale Gesundheitliche Aufgaben (BBGes), Institute of Toxicology--Clinical Toxicology and Poison Control Center Berlin, Clinical Toxicology and Pharmacology, Oranienburger Str. 285, 13437 Berlin, Germany. grobosch.tox@bbges.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Grobosch
authors.forename: Boris
authors.initials: B
authors.lastname: Angelow
authors.forename: Lena
authors.initials: L
authors.lastname: Schönberg
authors.forename: Dagmar
authors.initials: D
authors.lastname: Lampe
mesh_terms: D015110:4-Hydroxycoumarins / Q000097:blood* / Q000506:poisoning*; D000925:Anticoagulants / Q000097:blood / Q000506:poisoning; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D006801:Humans; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D008875:Middle Aged; D011041:Poisoning / Q000188:drug therapy; D012378:Rodenticides / Q000097:blood / Q000506:poisoning; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D012378:Rodenticides; D014812:Vitamin K; C021636:bromadiolone