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Cardiovascular drugs
Published in Bev-Lorraine True, Robert H. Dreisbach, Dreisbach’s HANDBOOK of POISONING, 2001
Bev-Lorraine True, Robert H. Dreisbach
Single doses of these compounds are not dangerous. Fatalities have been recorded after the following repeated daily doses of anticoagulants: dicumarol, 100 mg; ethyl biscoumacetate, 0.6 g; phenindione, 200 mg. The dangerous dosage of warfarin and diphacinone is 10–100 mg daily. The exposure limit for warfarin and pindone is 0.1 mg/m3. The single-dose LD50 for brodifacoum in rats is 0.67 mg/kg. The single dose of brodifacoum that would be dangerous in humans is unknown.
Intravenous phytonadione administered orally in reducing warfarin-related coagulopathy
Published in Clinical Toxicology, 2022
Jordan H. Rice, Peter Akpunonu, George A. Davis, Adam Dugan, Jamie Litteral, Ashley N. Webb, Alexandra Wiegand, Abby Bailey, Regan A. Baum
Widespread shortages of phytonadione tablets have prevented retails pharmacies and institutions from ordering an adequate and affordable supply to provide to patients. Utilizing the IV formulation orally may be indicated in times of shortage and high cost. Institutions in the US participating in the 340B program may be able to procure phytonadione and provide it to their patients at a reduced cost. In addition increased product availability, using the IV formulation administered orally may be associated with significant cost savings [8]. The cost of commercially available phytonadione tablets tripled from 2014 to 2016 [8,9]. At the time of this publication, the wholesale acquisition cost of the tablets is $9.92 per mg, while the cost of the IV solution is $4.36 per mg (per UK HealthCare’s primary wholesaler). Given the recent interest in this formulation due to the outbreak of synthetic marijuana contaminated with brodifacoum, the findings of this retrospective study of the use of intravenous phytonadione for warfarin related coagulopathy could be utilized in the management of these patients due to significant cost-savings and increased product availability [10]. For a patient requiring treatment with 88 grams of phytonadione over the course of 7 months due to brodifacoum exposure, this translates to a cost savings of approximately $489,280 using the IV formulation.
Pregnancy outcomes after suicide attempts by self-poisoning and drug overdose: experience of a clinical pharmacology consultation service in Izmir, Turkey
Published in Journal of Obstetrics and Gynaecology, 2018
Although some agents can cause bleeding and pregnancy complications, the drugs taken for suicide attempts do not seem to be harmful to the human foetus. In our survey, two pregnant women experienced vaginal bleeding after taking ergotamine or rodenticide. The pregnancy with a high dose of ergotamine exposure resulted in a spontaneous abortion, but the other pregnancies resulted in healthy live births. Ergotamine poisoning can promote uterine contractions, and hence may cause foetal harm or abortion. Ergot alkaloids are contraindicated in all trimesters, but there are no conclusive data of an increased risk of birth defects. Brodifacoum and other superwarfarin rodenticides may also lead to fatal or nonfatal bleeding from any tissue or organ. Single cases resulting in a healthy birth, stillbirth, maternal and neonatal coagulopathy have been described following a rodenticide exposure during pregnancy. Our case of a woman who took brodifacoum at 12 weeks of gestation resulted in a maternal coagulopathy recovered completely. At week 39 of gestation, she delivered a healthy baby weighing 3400 g, measuring 50.1 cm in length (both 50th to 75th percentile).
Case of brodifacoum-contaminated synthetic cannabinoid
Published in Clinical Toxicology, 2019
Sarah B. Riley, Matthew Sochat, Karen Moser, Kara L. Lynch, Rosanna Tochtrop, T. Scott Isbell, Anthony Scalzo
PT/INR and PTT mixing studies showed a factor deficiency pattern. Lupus anticoagulant was not detected. Coagulation factor testing revealed decreased activity of vitamin K-dependent factors (II, VII, IX, X) and normal activity of factors V and VIII. With high-dose intravenous phytonadione and fresh frozen plasma initially, the coagulopathy corrected. Lipophilic vitamin levels were normal, ruling out malabsorption. Qualitative anticoagulant testing by liquid chromatography tandem mass spectrometry (LC-MS/MS) detected brodifacoum in blood. At this time, the patient admitted to smoking SCRAs 3 weeks prior. Our regional poison control center informed us of several additional recent Midwestern cases of SCRA-related brodifacoum poisoning.