title: Treatment of brodifacoum overdose with prothrombin complex concentrate.
abstract: OBJECTIVE
  A case of brodifacoum overdose and its treatment with prothrombin complex concentrate (PCC) are reported.
  
  
  CONCLUSIONS
  A 44-year-old Caucasian woman weighing 62 kg arrived at the emergency department with a chief complaint of lower left leg pain for two days. A computed tomography (CT) scan of the abdomen revealed perihepatic fluid collection (likely a hematoma), a small-bowel intramural hematoma, and blood in the paracolic gutter. A CT scan of the patient's left foot showed soft tissue swelling without evidence of fracture or dislocation. The patient was diagnosed with left extremity compartment syndrome secondary to hematoma and trauma. The patient had a history of depression and anxiety and eventually admitted to ingesting large doses of brodifacoum the week prior with suicidal intentions. The patient was treated with phytonadione 20 mg i.v., 1 unit of fresh frozen plasma (FFP), and 1 unit of packed red blood cells. Laboratory test values measured in the intensive care unit revealed an International Normalized Ratio (INR) of 15, a prothrombin time of >120 seconds, and a partial prothromboplastin time of >180 seconds. After consulting with a local poison center, phytonadione 50 mg i.v., PCC 3100 units, and 4 units of FFP were immediately administered to reverse the patient's coagulopathy. The dose of oral phytonadione was lowered based on INR stability. Once the coagulopathy was stabilized, the patient was transferred to an inpatient psychiatric facility on phytonadione 10 mg daily orally to maintain a stable INR.
  
  
  CONCLUSIONS
  A 44-year-old woman who intentionally ingested brodifacoum was successfully treated with phytonadione, PCC, and FFP.
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Yuchen
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Viktoriya
authors.initials: V
authors.lastname: Kotik
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. germin.fahim@pharmacy.rutgers.edu.
authors.forename: Germin
authors.initials: G
authors.lastname: Fahim
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Sayee
authors.initials: S
authors.lastname: Alagusundaramoorthy
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Sherif Ali
authors.initials: SA
authors.lastname: Eltawansy
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Scott
authors.initials: S
authors.lastname: Mathis
authors.affiliation: Yuchen Wang, Pharm.D., is Postgraduate Year 1 (PGY1) Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Long Branch, NJ. Viktoriya Kotik, Pharm.D., is PGY1 Pharmacy Resident, Department of Pharmacy, Monmouth Medical Center, Southern Campus, Lakewood, NJ. Germin Fahim, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, and Internal Medicine Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch. Sayee Alagusundaramoorthy, M.D., is PGY1 Medical Resident, Department of Internal Medicine; Sherif Ali eltawansy, M.D., is Postgraduate Year 2 Medical Resident, Department of Internal Medicine; and Scott Mathis, Pharm.D., is Director of Pharmacy, Department of Pharmacy, Monmouth Medical Center, Long Branch. Julie Saleh, Pharm.D., BCPS, is Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, and Critical Care Pharmacist, Department of Pharmacy, Monmouth Medical Center, Long Branch.
authors.forename: Julie
authors.initials: J
authors.lastname: Saleh
mesh_terms: D015110:4-Hydroxycoumarins / Q000506:poisoning*; D000328:Adult; D000925:Anticoagulants / Q000506:poisoning*; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011517:Prothrombin Time / Q000379:methods; D016896:Treatment Outcome
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; C013418:bromfenacoum