Kemirici Zehirlerindeki Superwarfarine Maruziyet: Bir Ergende Uzun Süreli Kanama Kusuru Gelişmesi

Abstract

Superwarfarins which are long-acting, potent anticoagulants are used as rodenticides. Difenacoum is a second generation superwarfarin that inhibits the vitamin K-dependent steps in the synthesis of clotting factors II, VII, IX and X. A 15-year-old adolescent boy presented with persistent nose and gum bleeding. In past medical history there was no event suggesting coagulation defect. Coagulation assays suggested vitamin K dependent factor deficiency. Treatment was started with fresh frozen plasma and 20 mg intravenous vitamin K (phytomenadion). High dose phytomenodion peroral in three divided doses normalized coagulation tests and controlled gum and nose bleeding. When exposure to rodenticide was questioned, such an exposure by inhalation and skin was reported during cleaning the cellar. Duration of the vitamin K dependency was two years. Exposure to superwarfarin containing rodenticides causes severe longlasting bleeding deficiency. These products must have labels warning about dangers of exposure and they must be sold in pharmacies.