Brodifacoum poisoning with toxicokinetic data

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 45; no. 5; pp. 487 - 489
• Main Authors: OLMOS, Valentina, LOPEZ, Clara Magdalena
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Taylor & Francis 01.06.2007
• Subjects: 4-Hydroxycoumarins - blood; 4-Hydroxycoumarins - pharmacokinetics; 4-Hydroxycoumarins - poisoning; Anticoagulants - blood; Anticoagulants - pharmacokinetics; Anticoagulants - poisoning; Biological and medical sciences; Female; Hemorrhage - blood; Hemorrhage - chemically induced; Humans; Lung Diseases - blood; Lung Diseases - chemically induced; Medical sciences; Middle Aged; Pesticides, fertilizers and other agrochemicals toxicology; Prothrombin Time; Rodenticides - blood; Rodenticides - pharmacokinetics; Rodenticides - poisoning; Stomach Diseases - blood; Stomach Diseases - chemically induced; Suicide, Attempted; Toxicology; South America; Argentina; America; Case study; Human; Toxicokinetics; Toxicity; Coumarine derivatives; Pesticides; Toxicokinetic; HPLC chromatography; Poisoning; Rodenticide; Brodifacoum; HPLC
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650701354093

The case of a 46-year-old woman who survived after a brodifacoum poisoning is presented. The patient was admitted due to a severe coagulopathy. Initial prothrombin time and activated partial thromboplastin time were both greater than 110 seconds and the patient suffered severe gastric and pulmonary hemorrhage requiring fresh frozen plasma transfusion and parenteral phytonadione administration (up to 100 mg per day). Serum brodifacoum levels were determined by HPLC during seven months. Five days after admission, serum brodifacoum level was 1302 ng/ml. Serum brodifacoum levels decreased till day 209 when became not detectable. Brodifacoum elimination showed a first order kinetic and a 56-day half-life. Investigation of superwarfarin should be considered in any patient with vitamin K dependent coagulation disorder. It would be also useful to obtain periodic brodifacoum levels and build the corresponding elimination curve to help direct phytonadione therapy in poisoned patients.