title: Notable pink excreta and severe myocardial suppression in superwarfarin (difethialone) intoxication.
abstract: Patients rarely consult physicians before developing coagulopathy or bleeding in most reported cases of superwarfarin intoxication. A 57-year-old woman ingested red-dyed pellets of anticoagulant rodenticide containing difethialone and warfarin as well as tablets of nitrazepam. Although she presented to the hospital in a comatose state, notable pink-colored excreta hinted at the consumption of anticoagulant rodenticide, which led to the early diagnosis of superwarfarin intoxication. Supplementation of large doses of intravenous and oral vitamin K successfully prevented coagulopathy and bleeding. On the other hand, temporary and reversible myocardial suppression was extremely severe, and required the introduction of percutaneous cardiopulmonary support.
authors.affiliation: Department of Emergency & Critical Care Medicine, School of Medicine, Kitasato University of Kanagawa, Japan. yk119@kitasato-u.ac.jp
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Kamijo
authors.forename: Chie
authors.initials: C
authors.lastname: Sato
authors.forename: Kuniko
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Kazui
authors.initials: K
authors.lastname: Soma
mesh_terms: D015110:4-Hydroxycoumarins / Q000008:administration & dosage / Q000633:toxicity*; D000925:Anticoagulants / Q000008:administration & dosage / Q000633:toxicity*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D009567:Nitrazepam / Q000008:administration & dosage / Q000633:toxicity; D012378:Rodenticides / Q000008:administration & dosage / Q000633:toxicity*; D014812:Vitamin K / Q000008:administration & dosage / Q000627:therapeutic use; D014859:Warfarin / Q000008:administration & dosage / Q000633:toxicity
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D004396:Coloring Agents; D012378:Rodenticides; D014812:Vitamin K; D014859:Warfarin; D009567:Nitrazepam; C013418:bromfenacoum; C060340:difethialone