Citation

Tole M, LaBedz S, Feinstein DL, Rubinstein I. Lung 2019; 197(3): 349-352.

Affiliation

Research and Development Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA. irubinst@uic.edu.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00408-019-00227-2

PMID

31004190

Abstract

A large-scale outbreak of life-threatening, inhaled synthetic cannabinoids (Spice/K2)-associated coagulopathy with bleeding complications was recently reported in Illinois. The causative agents were brodifacoum, difenacoum, and bromadiolone, potent, long-acting, 4-hydroxycoumarin anticoagulant rodenticides (LAAR) that were mixed with Spice/K2 products procured and then inhaled by the victims. We report on 3 poisoned patients who reside in underserved, socioeconomically disadvantaged neighborhoods of Chicago that were admitted and treated successfully at two inner-city, tertiary care hospitals in Chicago. The patients were discharged from the hospitals on daily long-term high-dose oral vitamin K₁ (VK₁), provided free of charge. However, 2 patients were lost to follow-up prior to safe discontinuation of oral VK₁ therapy. The third patient was treated and followed successfully for 7 months when VK₁ was discontinued. We conclude that prolonged oral VK₁ therapy and follow-up of acute, life-threatening LAAR poisoning are variable and present challenges to healthcare providers. Appropriate practice guidelines to improve patient access and adherence to daily high-dose oral VK₁ therapy and follow-up should be developed and implemented.

Language: en

Keywords

Brodifacoum; Bromadiolone; Difenacoum; Rodenticide; Superwarfarins; Vitamin K