Anticoagulant Rodenticide Intoxication Research Articles

Anticoagulant rodenticide intoxication in a dog with pericardial effusion and a heart base mass‐like effect

AbstractA 4‐year‐old American Pitbull terrier presented for acute onset of a honking cough, vomiting and anorexia. Thoracic radiographs revealed tracheal narrowing consistent with a mass effect or tracheal collapse. The dog was hospitalised but acutely developed respiratory distress, syncope and pale mucous membranes. Moderate pleural effusion and a heart base mass were noted on echocardiographic examination as well as evidence of cardiac tamponade. Coagulation times were severely prolonged. After additional discussion with the owners, rodenticide exposure was considered possible. The owners elected humane euthanasia. A necropsy revealed gross evidence of intrathoracic haemorrhage and a heart base mass consistent with a haematoma. There was no evidence of neoplasia on histopathological evaluation of the tissues. A final diagnosis of rodenticide intoxication was made. This case report demonstrates the importance of considering anticoagulant rodenticide intoxication in patients with a history of pericardial effusion. It is also important to consider a haematoma as a differential diagnosis when a heart‐associated mass is visualised in patients with pericardial effusion.

Anticoagulant Rodenticide Toxicity in Terrestrial Raptors: Tools to Estimate the Impact on Populations in North America and Globally.

Anticoagulant rodenticides (ARs) have caused widespread contamination and poisoning of predators and scavengers. The diagnosis of toxicity proceeds from evidence of hemorrhage, and subsequent detection of residues in liver. Many factors confound the assessment of AR poisoning, particularly exposure dose, timing and frequency of exposure, and individual and taxon-specific variables. There is a need, therefore, for better AR toxicity criteria. To respond, we compiled a database of second-generation anticoagulant rodenticide (SGAR) residues in liver and postmortem evaluations of 951 terrestrial raptor carcasses from Canada and the United States, 1989 to 2021. We developed mixed-effects logistic regression models to produce specific probability curves of the toxicity of ∑SGARs at the taxonomic level of the family, and separately for three SGARs registered in North America, brodifacoum, bromadiolone, and difethialone. The ∑SGAR threshold concentrations for diagnosis of coagulopathy at 0.20 probability of risk were highest for strigid owls (15 ng g-1 ) lower and relatively similar for accipitrid hawks and eagles (8.2 ng g-1 ) and falcons (7.9 ng g-1 ), and much lower for tytonid barn owls (0.32 ng g-1 ). These values are lower than those we found previously, due to compilation and use of a larger database with a mix of species and source locations, and also to refinements in the statistical methods. Our presentation of results on the family taxonomic level should aid in the global applicability of the numbers. We also collated a subset of 440 single-compound exposure events and determined the probability of SGAR-poisoning symptoms as a function of SGAR concentration, which we then used to estimate relative SGAR toxicity and toxic equivalence factors: difethialone, 1, brodifacoum, 0.8, and bromadiolone, 0.5. Environ Toxicol Chem 2024;00:1-11. © 2024 His Majesty the King in Right of Canada and The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC Reproduced with the permission of the Minister of Environment and Climate Change Canada.

Rodenticide poisoning leading to cerebral hemorrhage: A case report.

Anticoagulant rodenticides (ARs) are a substantial fraction of murine types. AR poisoning causes bleeding from the skin, mucous membranes, and multiple organs. However, reports of AR-induced cerebral hemorrhage are scarce. A 40-year-old male presented with dizziness, headache, and limb weakness for 5 days and with coagulopathy. Two days prior to the onset of these symptoms, the patient was exposed to dead mice. Rodenticide intoxication-induced cerebral hemorrhage. Vitamin K1 infusion, administration of dehydrating agents to reduce intracranial pressure, and correction of acid-base and electrolyte imbalances. After 9 days of treatment, the patient's symptoms were relieved, and reexamination revealed that coagulation parameters returned to normal levels. The patient was eventually discharged for observation with oral vitamin K1. Rodenticide poisoning can lead to intracerebral hemorrhage, and treatment with vitamin K1 infusion is effective. Rodenticide poisoning-induced cerebral hemorrhage is rarely reported. Because its symptoms are nonspecific, it is easy to miss the diagnosis or misdiagnose. When patients present with direct and indirect symptoms such as dizziness, headache, and limb weakness, rodenticide poisoning should be considered. Coagulation function and head computed tomography or magnetic resonance imaging examination should be performed at the earliest to confirm the diagnosis and provide timely treatment.

Anticoagulant rodenticide poisoning in dogs: Retrospective analysis of clinical and laboratory diagnostic data

In this retrospective study, patient records of dogs suffering from poisoning with coumarin derivatives were evaluated to characterize the clinical appearance more precisely. Retrospective data analysis included 52 dogs with hemostaseologically proven anticoagulant rodenticide poisoning which were treated as inpatients at the Clinic for Small Animals between September 2011 and October 2018. In only 2 dogs (4%) the intake of poison could be observed with certainty. The most common clinical signs observed were reduced general behavior (79%), pallor of the mucosa (79%), anorexia (60%), and dyspnea/tachypnea (60%). In contrast, macroscopically visible internal and external bleedings occurred less frequently. Initially, all cases showed a highly altered prothrombin time and most patients a considerably prolonged activated partial thromboplastin time. Anemia was present in 75% of patients. All dogs included in the study received initially an intravenous treatment with 10 mg/kg vitamin K1. Pretreatment with 1 mg/kg prednisolone was given for prophylaxis of possible incompatibility reactions. No patient showed signs of anaphylactic reaction. Transfusions of whole blood or concentrated red cells were given to only 10 of the 52 animals; only one received 2 transfusions of erythrocytes. 94% of the animals could be discharged home for outpatient therapy after a median length of hospitalization of 3 days (1-9 days) with physiological or almost physiological coagulation test results. Anticoagulant rodenticide poisoning is often associated with non-specific symptoms and good prognosis if treated adequately. Coagulation diagnostics is always indicated in cases with unclear disorders. In life-threatening emergencies, immediate intravenous infusion of high-dose vitamin K1 is a very effective treatment and results in a rapid increase in coagulation factor activity.

Ultrasound features of an unusual intramural gastric haemorrhage secondary to rodenticide intoxication in a dog

AbstractA 3‐year‐old, neutered, female, mix‐breed dog was presented with a history of acute haemorrhagic vomiting, diarrhoea, anorexia and lethargy. The patient had a hyperkinetic pulse, pale mucous membranes, bilateral hyphema and the capillary refill time was increased. Coagulation testing showed increased values. Abdominal ultrasound revealed diffuse thickening of the submucosal layer with hyperechoic peritoneum and enlargement of the gastric lymph node. The presumptive diagnosis was gastric wall haemorrhage secondary to rodenticide intoxication. The dog responded to treatment and was discharged after 48 hours. Fifteen days later, the thickness and layering of the stomach wall was normal. Gastric wall haemorrhage is a rare condition in dogs with rodenticide intoxication, which requires a biopsy for confirmation. However, the risk of haemorrhage does not make this feasible. In this case, the authors suspect that submucosal gastric thickening was secondary to anticoagulant rodenticide intoxication based on history, clinical examination, haematological analysis and coagulation testing.

Toxic substances in the household - cases of poisoning, therapy, complications

There are many toxic substances used in our houses. Rodent poisons are not the most common group of substances, but cases of poisoning still occur. Long-acting anticoagulant rodenticides, also called superwarfarins, are known for their greater potency, longer half-life and delayed onset of symptoms. Cases of superwarfarin poisoning can pose a diagnostic and clinical challenge due to a wide array of presentations and prolonged severe coagulopathy requiring months of high-dose oral vitamin K therapy. The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding.We discuss a case of self-poisoning with long-acting anticoagulant rodenticides with a little presentation of sympthoms and disscus about another cases based on the found articles.

Anthropogenic threats to owls: Insights from rehabilitation admittance data and rodenticide screening in Texas.

Owls (Strigiformes) provide myriad ecosystem services and are sentinels for ecosystem health. However, they are at continued risk from anthropogenic threats such as vehicle collisions, entanglement with human-made materials, and exposure to anticoagulant rodenticides (ARs), a widespread pesticide known to affect owls. Texas is an important region for numerous migratory and non-migratory owl species in the United States (US), yet assessments of threats owls face here are lacking preventing the development of informed conservation strategies. This study coupled assessment of admittance data from two wildlife rehabilitation centers in Texas with AR liver screening to (1) identify which species of owls are commonly admitted, (2) evaluate seasonality of admittance, and (3) assess causes of admittance for owls in Texas. Between 2010 and 2021, 1,620 owls were admitted into rehabilitation, representing eight species of which the Great-horned Owl (Bubo virginianus) was the most common. For all owls combined admittance rates were highest in the spring, driven by an influx of juveniles (n = 703, 43.40%). The leading cause of admittance amongst species was 'no apparent injury' (n = 567, 34.94%). Where clear diagnoses could be made, the leading causes of admittances were 'entrapment in human infrastructure' (n = 100, 6.11%) and 'collision with vehicles' (n = 74, 4.56%). While the admittance data did not reveal any cases of AR poisoning, liver screening demonstrated high incidences of AR exposure; of 53 owls screened for ARs, 50.94% (n = 27) tested positive with 18 showing exposure to multiple ARs. Brodifacoum was the most frequently detected AR (n = 19, 43.18%) and seven owls (25.93%) tested positive within lethal ranges. Our results suggest that owls in Texas are at risk from myriad anthropogenic threats and face high exposure rates to ARs. In doing so, our results can inform conservation strategies that mitigate anthropogenic threats faced by owls in Texas and beyond.

Clinical Use of Canine Thawed Refrigerated Plasma: A Historical Case Series.

Thawed plasma (TP) refers to defrosted fresh frozen plasma stored refrigerated. TP is used in human medicine for the rapid provision of coagulation factors and resuscitation of haemorrhagic shock, but its use in dogs is poorly described. The objectives of this historical case series were to describe the reasons for TP transfusion, treatment outcomes, and adverse events associated with canine TP transfusions in a veterinary teaching hospital. We hypothesised that TP would be used most commonly for the treatment of haemorrhage secondary to anticoagulant rodenticide intoxication and trauma. Blood bank plasma transfusion logs were searched to identify dogs that received at least one unit of TP between December 2015 and June 2021. Briefly, 166 dogs received a total of 262 units of TP. Anticoagulant rodenticide intoxication (37/166, 22.3%) was the most common reason for transfusion, followed by traumatic haemorrhage (23, 13.9%) and spontaneous haemoperitoneum (22, 13.2%). The majority of dogs received one unit of TP (111/166, 67.1%) and pRBCs were commonly simultaneously transfused with TP (65, 39.2%). Severe prolongations of prothrombin time and activated partial thromboplastin time were reduced following TP transfusions. Allergic reactions were the most common transfusion reaction (19/166, 11.4%). Most dogs survived to discharge (101/166, 60.8%).

Blood Transfusion from a Magellanic Great Horned Owl (Bubo virginianus magellanicus) to a Barn Owl (Tyto alba): A Successful Case of Xenotransfusion.

This report describes successful transspecies blood transfusion from a Magellanic horned owl (Bubo virginianus magellanicus) to a barn owl (Tyto alba). The barn owl was admitted to a wildlife rehabilitation center with severe anemia (packed cell volume [PCV] = 6.7%) from suspected anticoagulant rodenticide poisoning. Procedures performed included patient stabilization, pharmacological treatment, and persistent monitoring following the blood transfusion. The patient's PCV was measured daily, increasing progressively, and attaining a normal value for the species (PCV > 40%) on the eighth day posttransfusion. With no possibility of obtaining a same-species donor and because of the serious condition of the patient and unfavorable prognosis, a decision was made to perform the xenotransfusion. The result was a successful recovery and ultimately the release of the owl into its natural habitat. We concluded that xenotransfusion for avian species should be considered in cases with no possibility of obtaining a homologous donor.

Plastic ingestion in an emaciated red kite (Milvus milvus) in England

AbstractThe red kite (Milvus milvus) was successfully re‐introduced into England in 1989, although the population continues to face anthropogenic threats. In this report, we describe evidence of plastic ingested in the ventriculus of an adult male red kite that was emaciated. In addition, dried blood was found on the feathers overlying both wings, and subcutaneous haemorrhage was identified. Toxicology tests revealed toxic levels (>100 ng/g) of second‐generation anticoagulant rodenticides (difenacoum 3.0 ng/g, brodifacoum 734.9 ng/g) in the liver of this red kite. Three possible contributors to mortality were considered: starvation from the ingestion of plastic preventing normal digestion, collision‐related trauma and second‐generation anticoagulant rodenticide poisoning. This is the first report of plastic ingestion in a red kite. The case highlights the importance of carrying out postmortem examinations as part of post‐release health surveillance and identifies plastic ingestion as a potential anthropogenic threat facing the red kite population in England.

Retrospective Evaluation of Clinical Bleeding in Dogs With Anticoagulant Rodenticide Toxicity—A Multi-Center Evaluation of 62 Cases (2010–2020)

ObjectiveTo evaluate the most common locations of hemorrhage in dogs diagnosed with anticoagulant rodenticide intoxication.AnimalsDogs presenting with hemorrhage secondary to anticoagulant rodenticide intoxication between at two university veterinary teaching hospitals.ProceduresMedical records were searched from the years 2010 through 2020 and all records from dogs treated for hemorrhage secondary to anticoagulant rodenticide intoxication were reviewed. Dogs were diagnosed with anticoagulant rodenticide intoxication based on the combination of known exposure and prolonged coagulation testing, including prothrombin and activated thromboplastin time, or based on gas chromatography-mass spectrometry (GCMS). The diagnosis of hemorrhage was made based on physical exam findings, point-of-care ultrasound findings or radiography.ResultsSixty-two dogs met the inclusion criteria and were included in the study. The most common sites of hemorrhage included: pleural space (hemothorax 37%), pulmonary parenchyma (24%), abdomen (24%), skin/subcutaneous (21%), gastrointestinal tract (18%), pericardium (13%), oral cavity (13%), nasal cavity (11%), ocular (8%), and urinary tract (7%). Overall, forty-five dogs (73%) had evidence of cutaneous or mucosal hemorrhage while thirty-three (53%) of dogs had evidence of cavitary hemorrhage. Forty-five percent of dogs had hemorrhage noted at only one site, while 55% experienced hemorrhage at more than one site. The location of hemorrhage and total number of hemorrhagic sites was not associated with survival or transfusion requirement.Conclusions and Clinical RelevanceIn conclusion, this study highlights that dogs with anticoagulant rodenticide intoxication present with diverse locations of hemorrhage and the majority of dogs had non-cavitary hemorrhage noted.

Anticoagulant Rodenticides Poisonings in Humans and Animals – Short Review

Anticoagulant rodenticides (AR) are among the most commonlyused rodent control pesticides. The current second-generationrodenticides in worldwide use are referred to as superwarfarins.These substances have relatively low toxicity to humans but significanttoxicity to animals, including pets.AR work at the level of hepatocytes by blocking the synthesisof plasma coagulation factors II, VII, IX, and X as well as proteinsC, S, and Z, resulting in severe coagulation disorders predominantin the clinical picture.Deaths associated with AR poisoning are the result of haemorrhagesinto the gastrointestinal tract, peritoneal cavity, or intracranialcavities.Medico-legal diagnosis of AR poisonings is based on the clinicalpicture, autopsy, and histopathological and toxicological examinations.

Pesticides threaten an endemic raptor in an overseas French territory

The Réunion harrier is an endangered raptor that is endemic to Réunion Island. Anticoagulant rodenticides (ARs) are widely applied on the island to prevent leptospirosis transmission to humans and limit the damage to sugarcane crops caused by rats and house mice. As these pesticides exhibit a high risk of secondary poisoning for rodent predators, we examined whether the Réunion harriers were exposed to and potentially poisoned by ARs. The AR concentrations in the livers of 58 harrier carcasses collected from 1999 to 2016 were measured. Both the temporal and spatial trends were analysed, and the influences of individual and landscape characteristics on the liver concentrations and potential poisoning were determined. AR residues were detected in 93% of the harriers. Difenacoum was the most frequently found (73% of positive cases), while brodifacoum and bromadiolone showed the highest concentrations. Both the numbers of harriers exposed to ARs and of individuals that were potentially poisoned increased over time. This is particularly alarming as the number of harriers potentially poisoned by brodifacoum increased dramatically beginning in 2014. We also showed that the landscape composition of the townships influenced the AR exposure, as the concentrations increased with the proportion of urban areas and showed a peak at 25% of the township under sugarcane cultivation. We conclude that AR poisoning is likely a main threat for Réunion harrier conservation and propose several actions to limit poisoning.

A review: poisoning by anticoagulant rodenticides in non-target animals globally.

Worldwide use of anticoagulant rodenticides (ARs) for rodents control has frequently led to secondary poisoning of non-target animals, especially raptors. In spite of the occurrence of many incidents of primary or secondary AR-exposure and poisoning of non-target animals, these incidents have been reported only for individual countries, and there has been no comprehensive worldwide study or review. Furthermore, the AR exposure pathway in raptors has not yet been clearly identified. The aim of this review is therefore to comprehensively analyze the global incidence of primary and secondary AR-exposure in non-target animals, and to explore the exposure pathways. We reviewed the published literature, which reported AR residues in the non-target animals between 1998 and 2015, indicated that various raptor species had over 60% AR- detection rate and have a risk of AR poisoning. According to several papers studied on diets of raptor species, although rodents are the most common diets of raptors, some raptor species prey mainly on non-rodents. Therefore, preying on targeted rodents does not necessarily explain all causes of secondary AR-exposure of raptors. Since AR residue-detection was also reported in non-target mammals, birds, reptiles and invertebrates, which are the dominant prey of some raptors, AR residues in these animals, as well as in target rodents, could be the exposure source of ARs to raptors.

Retrospective characterization of canine coagulopathies using the turbidimetric ACL-TOP 300 analyzer (2014-2015): Forty-seven dogs.

To characterize disseminated intravascular coagulation (DIC), liver failure (LF), post-hepatic cholestasis (PHC), and anticoagulant rodenticide intoxication (ROD) in dogs using an immunoturbidimetric coagulation analyzer and to characterize the relationship between clinical bleeding and bleeding parameters. Retrospective study (August 2014-July 2015). University teaching hospital. Forty-seven client-owned dogs diagnosed with DIC (n= 24), LF (n= 9), PHC (n= 5), or ROD (n= 9) based on history, clinical pathology, cytology, histopathology. or exploratory surgery. None. Median prothrombin time (PT), activated partial thromboplastin time (aPTT), and quantitative fribrinogen assay (QFA) were above the reference interval for DIC, LF, PHC and ROD with the exception of a normal QFA for LF. Clot curve analysis for DIC was characterized by elevated PT Delta, PT first derivative, and aPTT Delta, and normal for aPTT second derivative; all LF parameters were within the RI; all PHC parameters were above the RI; and ROD had elevated aPTT delta, but low aPTT second derivative. Coagulopathic bleeding recognized within the DIC group was characterized by median PT delta in mABS (milliabsorbance), first derivative and aPTT delta values in mABS within the RI at 35.0, 55.5 and 38, respectively. The nonbleeding DIC group median values of these same parameters were 189.5, 586.5 and 288, respectively. The classically utilized indicators of secondary hemostasis, PT and aPTT, were prolonged within all 4 groups; DIC, LF, PHC and ROD as expected. Fibrinogen concentration was increased in both PHC and ROD, decreased in LF and increased but with a bimodal distribution in DIC that correlated with clinical bleeding. The degree of PT and aPTT prolongation did not correlate with clinical bleeding in the DIC group, however clot curve analysis, did reveal an association.

The prevalence and correlates of anticoagulant rodenticide exposure in non-target predators and scavengers in Finland

The most common rodent control method worldwide is anticoagulant rodenticides (ARs), which cause death by internal bleeding. ARs can transfer to non-target predators via secondary exposure, i.e. by consuming contaminated rodents. Here we quantify the prevalence of seven AR substances in the liver tissues of altogether 17 mammalian or avian predator or scavenger species in Finland. In addition, we identify the environmental and biological factors potentially linked to secondary AR poisoning. No previous AR screenings have been conducted in the country, despite the widespread use of ARs and their potential impacts on the high levels of the ecosystem food chain. ARs were detected (≥0.3 μg/kg) in 82% of the 131 samples. The most prevalent and the AR with highest concentrations was bromadiolone (65% of samples). In 77% of the positive samples more than one (2–5) different ARs were detected. Of the environmental variables, we only found a weakly positive relationship between the coumatetralyl concentration and the livestock farm density. Conversely, overall AR concentration and number, as well as the concentration of three separate ARs (coumatetralyl, difenacoum and bromadiolone) differed among the three species groups tested, with the group “other mammals” (largely represented by red fox and raccoon dog) having higher values than the groups presented by mustelids or by birds. ARs are authorized only as biocides in Finland and a national strategy on risk management (e.g. for minimising secondary poisoning of non-target species) of ARs was adopted in 2011. Based on these results it appears that the risk mitigation measures (RMMs) either have not been followed or have not been effective in preventing wide scale secondary exposure. Continued monitoring of AR residues in non-target species is needed in order to evaluate the effectiveness of current RMMs and a need for new ones to reduce the risk of secondary poisoning.

Acute tracheal narrowing presumptively associated with anticoagulant rodenticide intoxication in a dog

A 3.5-year-old, spayed female, German shepherd-cross dog was presented with cough, hemoptysis, inspiratory stridor and fascial plane hematomas. Routine bleeding profile showed prolonged prothrombin time (PT) and partial thromboplastin time (PTT). Radiography revealed severe narrowing of tracheal lumen accompanied by increased thickness and opacity of its wall. Tracheal diameter was measured objectively, employing the ratio of its diameter (TD) to thoracic inlet distance (TI) and that of the midpoint between thoracic inlet and the carina (TT) to the 3r d rib width (3R), as well as the ratio of TT to predicted diameter of tracheal lumen [DPred (DPred cm = 0.47 (weight kg )0 3 9)]. All three ratios were found lower than normal. The space occupying effect of extensive and severe sub-mucosal hemorrhage due to anticoagulant rodenticide intoxication was incriminated.

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

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

Treatment of a long-acting anticoagulant rodenticide poisoning cohort with vitamin K1 during the maintenance period.

Currently, there are few guidelines for the use of vitamin K1 in the maintenance treatment of long-acting anticoagulant rodenticide (LAAR) poisonings. We explored factors in the treatment of LAAR poisoning during the maintenance period in order to suggest feasible treatment models.Data from 24 cases of anticoagulant rodenticide poisoning in our hospital were collected from January 2013 to May 2016. The patients' sex, age, coagulation function, total time from poisoning to treatment with vitamin K1 (prehospital time), vitamin K1 sustained treatment time (VKSTT), anticoagulant rodenticide category, and specific poison dosage were collected. Multivariate analysis was used to evaluate the correlation between vitamin K1 dosage and other factors during the maintenance period.Only VKSTT (partial regression coefficient -1.133, 0.59, P = 0.035) had an obvious influence on the therapeutic dose of vitamin K1 required during the maintenance period.After an initial pulse therapy, the bleeding and coagulation functions were stabilized, and the patients were subsequently treated with vitamin K1 during the maintenance period. Over time, the maintenance dose of vitamin K1 (10-120 mg/d, intravenous drip) was gradually decreased and was not related to toxicant concentration.

Anticoagulant rodenticide intoxication in east China: a three-year analysis

ABSTRACTThe study was designed to analyze the incidence and pattern of anticoagulant rodenticide intoxication in east China and to discuss strategies of diagnosis based on laboratory analysis experience. A total of 117 patients with anticoagulant rodenticide poisoning confirmed by toxicological analysis in east China were included in this study from 2011 to 2013. The mean concentration of anticoagulant rodenticide, age, and gender of these patients, as well as the mode and type of poisoning, were discussed. The age ranged from less than 1 to 80 years with the feeble preponderance of males (M = 53.0%, F = 47.0%). The 0–9 age group covered the largest ratio of these anticoagulant rodenticide poisoning patients. Accidental or voluntary ingestion seems to be the most common cause of intoxication, with still the poisoning cause being unknown for a large number of positive analyses. Bromadiolone was the most commonly observed anticoagulant rodenticide found in the biological samples, followed by brodifacoum. The concentrations of bromadiolone and brodifacoum that were detected in the first collected whole blood from each patient ranged from 1 to 878 ng/mL (mean 97.9 ng/mL) and from 0.5 to 1566 ng/mL (mean 225.1 ng/mL), respectively. The data analysis shows a high incidence of anticoagulant rodenticide poisoning without awareness of the poisoned subjects, clearly emphasizing the need for toxicological analysis in patients with vitamin K-dependent coagulation disorder and restriction on availability of anticoagulant rodenticide.