Citation

Bruno GR, Howland MA, McMeeking A, Hoffman RS. Ann. Emerg. Med. 2000; 36(3): 262-267.

Copyright

(Copyright © 2000, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI

10.1067/mem.2000.108317

PMID

10969235

Abstract

Ingestion of long-acting anticoagulant rodenticides such as brodifacoum can lead to prolonged and life-threatening coagulopathy. A paucity of conflicting information is available on brodifacoum's half-life and elimination pharmacokinetics. In addition, the optimal dose, duration, and route of administration of vitamin K(1) therapy are unknown. We report the case of a 52-year-old man who ingested eight 43-g boxes of a rodenticide (d-Con Mouse-Prufe II; 0.005% brodifacoum; Reckitt & Colman, Wayne, NJ). This case demonstrates that after stabilization with fresh frozen plasma, high-dose oral vitamin K(1) therapy ( congruent with 7 mg/kg per 24 hours divided every 6 hours) was effective in treating brodifacoum-induced coagulopathy. The concentration of vitamin K(1) required for normal coagulation in this case was less than the accepted value of 1 microg/mL, which is derived from a rabbit model. In this case, brodifacoum appears to follow zero-order elimination pharmacokinetics. In future cases of patients with ingestions of long-acting anticoagulants who present with coagulopathy, it may be useful to obtain serial brodifacoum concentrations to determine elimination curves to help predict the duration of oral vitamin K(1) therapy.

Language: en

Keywords

4-Hydroxycoumarins/blood/pharmacokinetics/*poisoning; Administration, Oral; Drug Overdose; Follow-Up Studies; Half-Life; Hemorrhage/chemically induced/drug therapy; Humans; Male; Metabolic Clearance Rate; Middle Aged; Plasma; Rodenticides/blood/pharmacokinetics/*poisoning; Suicide, Attempted; Vitamin K/administration & dosage/*therapeutic use