Clinical characteristics and treatments of anti-coagulant rodenticide poisoning in children lacking of poisoning history

Abstract

Objective To summarize the clinical characteristics, diagnosis and treatments of 50 children with no history of anti-coagulation rodenticide poisoning. Methods Fifty children lacking of poisoning history were admitted to our hospital from Feb 2011 to Dec 2015, who were due to hemorrhage and finally diagnosed as rodenticide poisoning.The clinical manifestation, characteristics of blood coagulation dysfunction, toxicology screening results and treatments of 50 cases were retrospectively analyzed. Results All 50 cases were from rural area, and denied the history of taking rodenticide by mistake.The time from the onset to admission to the hospital was from 1 d to 120 d, with an average of 11.66 d. Major clinical manifestations included: 34 cases(68%)of skin ecchymosis, 26 cases(52%)of epistaxis, 10 cases(20%)of bleeding gums and 4 cases(8%)of hematoma at the injection site, with PT 20 to over 200 s and APTT 31 to over 200 s(maximal detection value). The children were diagnosed as rodenticide poisoning when one of brodifacoum, bromadiolone, and diphacinone-sodium or combination of brodifacoum and bromadiolone were detected from their blood specimens, with an concentration of 5 to 3 270 μg/L.The diagnosed children were intravenous dripped with specific antagonist vitamin K1 and the critically ill children were added fresh frozen plasma.All children recovered from hemorrhage within 24 hours after treatment.The level of PT, APTT was close to normal after 3 to 7 days of treatment, and the using of vitamin K1 was accumulated about 30 to 70 mg.The children were given maintenance treatment of vitamin K1 for three months after discharge until the condition was stable. Conclusion Commonly used rodenticide has the characteristics of fat soluble, easy to accumulate, long incubation period, and long treatment period and so on.Children with no bleeding performance have the clinical tendency of acute bleeding, prolonged PT and APTT should be considered the possibility of rodenticide poisoning.Blood or urine samples should be screened for toxicology as soon as possible, and meanwhile children should be given antagonist treatment with special antidote vitamin K1 until the coagulation function is stable in normal range to avoid recurrence of the illness. Key words: Anti-coagulant; Rodenticide; Poisoning; Vitamin K1