By the time the patient presents, PR and activated partial thromboplastin time aPTT are universally prolonged. These tests only indicate a possibility of LAAR poisoning.
A high degree of suspicion is needed especially if not other cause for the coagulopathy is found. Delay in diagnosis is common especially in cases of unintentional consumption. Confirmation can be done by measurement of 4-hydroxycoumarin levels in blood using high-performance liquid chromatography with tandem mass spectrometry. The treatment is predominantly vitamin K supplementation. Fresh frozen plasma or prothrombin complex concentrates are needed in case of active bleeding.
Treatment with vitamin K maybe needed for several days to months. In a literature review, vitamin K supplementation was given from 28 to up to days. Vitamin K-dependent clotting factors begin to increase within 6—8 hours post treatment. There is no clear consensus on the right dose to use.
The initial dose of vitamin K used has varied from 0. Misdiagnosis of these patients is common especially if they are initially asymptomatic. Children are often misdiagnosed to have hemophilia. Poisoning should be suspected in patients with prolonged multisite hemorrhage and with elevated PT and PTT, no signs of disseminated intravascular coagulation, and with no cause for factor inhibitor.
Therapeutic plasma exchange has also been studied in LAAR poisoning. Brodifacoum has a high protein binding and low volume of distribution, which makes it ideal for removal by plasma exchange. Studies have shown benefit of therapeutic plasma exchange in children following an anaphylactic reaction to vitamin K administered for brodifacoum poisoning.
Rodenticide poisoning is an important health problem with a high case fatality rate especially with metal phosphides. Easy availability, over the counter or on e-commerce websites, and a lack of antidotes for rodenticides in our country pose an important health problem.
Improving public awareness regarding their lethality and strict monitoring of sales and usage of rodenticides could help to avoid indiscriminate use and poisoning. The LAAR toxicity should be suspected especially in unexplained prolonged coagulopathy with no other incriminating cause. National Center for Biotechnology Information , U.
Indian J Crit Care Med. Carol D'Silva 1 and Bhuvana Krishna 2. Author information Copyright and License information Disclaimer. Rodenticides are classified based on their toxicity as following refer Table 1 : Table 1 Classification of rodenticides based on toxicity with examples.
Highly toxic agents Strychnine Thallium Elemental phosphorous Metal phosphides Sodium monofluoroacetate Arsenic Moderately toxic agents Alpha-naphthyl thiourea Cholecalciferol Less toxic agents Warfarin Superwarfarins—brodifacoum, bromadiolone, chlorophacinone, difenacoum, and diphacinone Bromethalin Red squill. Open in a separate window. Epidemiology The global burden of rodenticide poisoning varies from region to region. Mode of Poisoning Ingestion—This is the most common mode reported. General Approach to Rodenticide Poisoning It is important to identify the compound as the clinical manifestations and treatment required vary.
Yellow Phosphorous Poisoning Yellow or white phosphorous is a waxy substance and is commonly used in fertilizers, fireworks, ammunition, and rodenticide preparations. Mechanism of Action Yellow phosphorous is a protoplasmic toxin affecting the hepatic, gastrointestinal, cardiovascular, and renal systems. Treatment There is no specific diagnostic test and measuring serum phosphorous levels is not entirely useful in estimating the possible amount of toxin consumed.
Initial treatment includes decontamination and supportive therapy. Aluminium and Zinc Phosphide Poisoning Phosphides are the commonest agent responsible for rodenticide poisoning in India. Mode of Poisoning It can occur through ingestion: accidental or intentional and through inhalation of liberated phosphine.
Mechanism of Action The phosphides react with hydrochloric acid and water to release phosphine gas. Toxikinetics Once phosphine is released in the stomach, it is rapidly absorbed from the gastrointestinal tract, enters the bloodstream, and reaches the liver, kidney, and brain. Clinical Features Manifestations of phosphide toxicity appear rapidly, usually presenting within 30 minutes following exposure.
Treatment There is no known antidote for the treatment of phosphide poisoning. Decontamination Gastric lavage is controversial in cases of phosphide poisoning as it can increase the rate of disintegration of the pesticide and increase toxicity.
Activated charcoal is beneficial to reduce toxicity due to metal phosphide ingestion. Supportive Treatment These patients should be monitored in an intensive care unit and closely observed daily for organ dysfunction.
Liver transplant has also been done in patients progressing to ALF. Coumarins are hepatotoxic in rats; however, the toxicity is much less in humans. They include brodifacoum, difenacoum, bromadiolone, and flocoumafen. Routes of Exposure Poisoning can occur through ingestion and rarely through inhalation or transcutaneous exposure. Table 2 Mean half-lives of vitamin K-dependent coagulation factors Diagnosis Laboratory evidence of deranged prothrombin time PT and international normalized ratio INR commonly occurs 48 hours post exposure and can last for several days depending on the compound consumed.
Treatment The treatment is predominantly vitamin K supplementation. Footnotes Source of support: Nil Conflict of interest: None. Clin Toxicol Phila ; 56 12 Acute pesticide poisoning: 15 years experience of a large north-west Indian hospital.
Clin Toxicol. J Forensic Leg Med. White phosphorus poisoning by oral ingestion of firecrackers or little devils: current experience in Ecuador.
Clin Toxicol Phila ; 49 1 — Ingestion of fireworks: rare cause of poisoning in children. Pediatr Emerg Care [Internet] ; 35 3 — Urbano-Fernandez O, Canizares L. Acute hepatotoxicity from ingestion of yellow phosphorus-containing fireworks. J Clin Gastroenterol. Clin Toxicol Phila. A guide to acquired vitamin K coagulophathy diagnosis and treatment: the Russian perspective.
Validation of a new liquid chromatography-tandem mass spectrometry ion-trap technique for the simultaneous determination of thirteen anticoagulant rodenticides, drugs, or natural products. J Anal Toxicol. PLoS Med. Clin Pharmacol Ther. Genetic control of dicumarol levels in man. J Clin Invest. Pharmacokinetics of ethyl biscoumacetate and its metabolite 7-hydroxy ethyl biscoumacetate in healthy volunteers. Int J Clin Pharmacol Ther. The enantiomers of phenprocoumon: pharmacodynamic and pharmacokinetic studies.
Clinical pharmacokinetics of oral anticoagulants. Clin Pharmacokinet. Acquired coagulopathy caused by intoxication with the superwarfarin-type anticoagulant rodenticide flocoumafen. Eur J Haematol. Chlorophacinone intoxication. A biological and toxicological study. J Toxicol Clin Toxicol. Pharmacokinetics of the enantiomers of acenocoumarol in man. Br J Clin Pharmacol. Dispositional and pharmacodynamic characteristics of brodifacoum in warfarin-sensitive rats.
Brodifacoum inhalation and its clinical manifestations in a Year-Old Caucasian man. Lab Med. Laboratory evaluation of difenacoum as a rodenticide. J Hyg Lond. N Engl J Med. Rodenticide-induced coagulopathy in a young child. A case of Munchausen syndrome by proxy. Am J Pediatr Hematol Oncol. Scand J Haematol. Superwarfarin ingestion treated successfully with prothrombin complex concentrate. Am J Emerg Med.
S every year. Young children, especially those under the age of 6, are at high risk of unintentional poisoning through ingestion. Safe rodent control and preventative measures can help you keep rats and mice out of your home while protecting your little ones from rodenticide poisonings. The following sections offer an overview of how kids get exposed, emergency measures, and how to prevent poisonings in the first place.
Residential use of rodenticides puts children at high risk of accidental poisoning in their own home. Rodenticide baits can be lethal for any mammal or bird that ingests them and are not only poisonous for rodents. Rodenticide as usually formulated as baits that come in different colors and forms such as pellets, grains, and blocks see picture of blue rodenticide pellets.
Some baits also include flavorings such as fish oil and peanut butter. As a result, all baits, especially the small and colored pellets, pose a high risk of poisoning for children who might mistake the bait for candy or food. It can be surprisingly difficult to keep these products out of the reach of children since baits — to be most effective — are usually placed on the floor, offering kids ready access. Rat poison comes in the form of pellets or cakes. Because rat poison often smells and tastes like food, it can be attractive to children and pets.
Rat poison can be very dangerous if ingested by children or pets. Most rat poison is made of a product that thins the blood. Symptoms may not develop for a couple of days.
By that time, serious damage may have already occurred. Do not wait for symptoms to appear. Print Share. Poison Control Center. Rat Poison.
0コメント