MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015
Topic: Toxicology / Environmental Injury
J01
OUTCOMES FOLLOWING BRODIFACOUM EXPOSURE REPORTED IN THE TOXIC REGISTRY (2010-2013)
B. Hatten 1, J. Westphalen 2, R. Vohra 3, L. Tormoehlen 4, P. Wax 5, J. Brent 1, On Behalf Of Toxic 6
1
Section Of Medical Toxicology, Department Of Emergency Medicine, University Of Colorado School Of Medicine, Aurora, Co, Usa, 2 Denver Health Residency In Emergency Medicine, Denver Health Medical Center, Denver, Co, Usa, 3 Emergency Medicine, Ucsf-Fresno, Fresno, Ca, Usa, 4 Departments Of Neurology And Emergency Medicine, Indiana University, Indianapolis, In, Usa, 5 Department Of Emergency Medicine, University Of Texas-Southwestern, Dallas, Tx, Usa, 6 Toxicology Investigators Consortium, American College Of Medical Toxicology Background: Since 2010, the Toxicology Investigators Consortium(ToxIC) Registry records all clinical consults seen by an international multi-center network of medical toxicologists in a standardized fashion. In recent years, the United States Department of Defense, Food and Drug Administration, Department of Health and Human Services, and Centers for Disease Control have developed lists of chemicals that are considered potential threat agents. Brodifacoum is one of the agents of interest. Methods: The Registry was queried from 2010-2013 for cases entered with an exposure to brodifacoum. Cases recorded as no or chronic exposure, no signs/symptoms, and signs/symptoms unlikely toxin-related were excluded. Sites reporting brodifacoum exposures were contacted for a case abstraction of the medical record. Results: 21 cases of brodifacoum exposure from 13 sites were identified. 10 cases from 5 sites were abstracted and available for analysis. 5/10 were female and 9/10 were adult patients. 7/10 had psychiatric comorbidities. All were admitted to the hospital with a mean length of stay of 3.9 days(range: 2-11 days). 2/10 required intubation. The median initial prothrombin time reported was 94.3 sec(range 13 sec to >200 sec). Dose of exposure was inconsistently reported. Treatment in all cases was initiated based on abnormal coagulation studies and presumed exposure. Only 1 case underwent brodifacoum confirmatory testing. 8/10 experienced spontaneous bleeding and 3 of these experienced bleeding in a noncompressible site. 1 death was reported in a case of prenatal maternal ingestion resulting in a postnatal intraventricular hemorrhage in the neonate. 6/10 cases were treated with fresh frozen plasma(median 3 units: range 1-20 units) and 1/10 was treated with Factor IX concentrate. 2/10 were treated with IV vitamin K. All surviving patients were discharged on an oral vitamin K regimen with a median daily dose of 100mg(range 10-300mg). 1 was treated with daily dosing, 4 were treated with 2x daily dosing, and 4 with 3x daily dosing. Conclusions: Coagulation abnormalities and spontaneous bleeding are common following brodifacoum exposure. In hospital treatment is variable but often includes fresh frozen plasma. High dose oral vitamin K was the mainstay of the discharge regimen.