Document Detail


Long-acting anticoagulant overdose: brodifacoum kinetics and optimal vitamin K dosing.
MedLine Citation:
PMID:  10969235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
G R Bruno; M A Howland; A McMeeking; R S Hoffman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  36     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-10-06     Completed Date:  2000-10-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  262-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA. grbruno510@msn.com
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MeSH Terms
Descriptor/Qualifier:
4-Hydroxycoumarins / blood,  pharmacokinetics,  poisoning*
Administration, Oral
Follow-Up Studies
Half-Life
Hemorrhage / chemically induced,  drug therapy
Humans
Male
Metabolic Clearance Rate
Middle Aged
Overdose
Plasma
Rodenticides / blood,  pharmacokinetics,  poisoning*
Suicide, Attempted
Vitamin K / administration & dosage,  therapeutic use*
Chemical
Reg. No./Substance:
0/4-Hydroxycoumarins; 0/Rodenticides; 12001-79-5/Vitamin K; 56073-10-0/bromfenacoum

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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