[ Intoxication au Brodifacoum ]
Volume 20, Issue 2, February 2016, Pages 327–332
Wafa Masri1, Ines Belwaer2, Nozha Brahmi3, Abderrazak Hedhili4, and Mouldi Amamou5
1 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
2 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
3 Service de Réanimation Médicale, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
4 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
5 Service de Réanimation Médicale, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
Original language: French
Copyright © 2016 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Anticoagulants are widely used pesticides in agriculture against rodents. The emergence of strains of rats resistant to warfarin led to the introduction of a new group of anticoagulant rodenticides: derivatives of 4-hydroxycoumarin (Brodifacoum, Bromadiolone, Difenacoum ...). The deliberate ingestion of large quantities of these products known by their long duration of action causes a disruption of several weeks to several months of hemostasis.
CASE REPORT: 20 year old comes to the emergency CAMU with a tremor and coma, requiring intubation and its implementation under mechanical ventilation. At 24 h after awakening, we note the presence of hematuria associated with a collapse of prothrombin (16%), prolonged partial thromboplastin time kaolin (T/M: 30s/50s), a collapse of fibrinogen (1.2 g/l) with a reduction factor of the Vitamin K dependent clotting II, VII, IX and X. The toxicological analysis of patient urine by HPLC shows the presence of brodifacoum
CONCLUSION: Brodifacoum poisoning is relatively serious. Research and dosage of anti-vitamin K anticoagulants by HPLC with diode array detector, must be requested before any disturbance of hemostasis of undetermined origin. Treatment with vitamin K should be installed early in effective dose from the decreased prothrombin and must be prolonged.
Author Keywords: poisoning, coumarins, brodifacoum.
Volume 20, Issue 2, February 2016, Pages 327–332
Wafa Masri1, Ines Belwaer2, Nozha Brahmi3, Abderrazak Hedhili4, and Mouldi Amamou5
1 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
2 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
3 Service de Réanimation Médicale, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
4 Laboratoire de toxicologie, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
5 Service de Réanimation Médicale, Centre d'Assistance Médicale Urgente, 10, rue aboulkacem chebbi Montfleury 1008, Tunisia
Original language: French
Copyright © 2016 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Anticoagulants are widely used pesticides in agriculture against rodents. The emergence of strains of rats resistant to warfarin led to the introduction of a new group of anticoagulant rodenticides: derivatives of 4-hydroxycoumarin (Brodifacoum, Bromadiolone, Difenacoum ...). The deliberate ingestion of large quantities of these products known by their long duration of action causes a disruption of several weeks to several months of hemostasis.
CASE REPORT: 20 year old comes to the emergency CAMU with a tremor and coma, requiring intubation and its implementation under mechanical ventilation. At 24 h after awakening, we note the presence of hematuria associated with a collapse of prothrombin (16%), prolonged partial thromboplastin time kaolin (T/M: 30s/50s), a collapse of fibrinogen (1.2 g/l) with a reduction factor of the Vitamin K dependent clotting II, VII, IX and X. The toxicological analysis of patient urine by HPLC shows the presence of brodifacoum
CONCLUSION: Brodifacoum poisoning is relatively serious. Research and dosage of anti-vitamin K anticoagulants by HPLC with diode array detector, must be requested before any disturbance of hemostasis of undetermined origin. Treatment with vitamin K should be installed early in effective dose from the decreased prothrombin and must be prolonged.
Author Keywords: poisoning, coumarins, brodifacoum.
Abstract: (french)
Les rodenticides anticoagulants sont largement utilisés en agriculture. L'émergence de souches de rats résistantes à la warfarine a conduit à l'introduction d'un nouveau groupe d'anticoagulant rodenticides : les dérivés de la 4-hydroxycoumarins (Brodifacoum, Bromadiolone, Difenacoum...). L'ingestion intentionnelle de grande quantité de ces produits connus pour leur longue durée d'action, cause une perturbation de plusieurs semaines à plusieurs mois de l'hémostase.
OBSERVATION: Un jeune de 20 ans est adressé aux urgences dans le coma avec des trémulations, nécessitant son intubation et sa mise sous ventilation mécanique. Au réveil 24 h après, on note la présence d'une hématurie associé à un effondrement du taux de prothrombine (16%), un allongement du temps cephaline kaolin (T/M: 30s/50s), un effondrement du taux de fibrinogène (1,2 g/l) avec une diminution des facteurs de la coagulation vitamine K dépendants II, VII, IX et X. L'analyse toxicologique des urines du patient par HPLC montre la présence du brodifacoum.
CONCLUSION: L'intoxication par le brodifacoum est relativement grave. La recherche et le dosage des anticoagulants anti-vitamine K, par HPLC avec détecteur à barrettes de diode, doivent être demandés devant toute perturbation de l'hémostase d'origine indéterminée. Le traitement par vitamine K doit être instauré précocement, à dose efficace, dès la constatation d'une diminution du TP et de manière prolongée.
Author Keywords: Coumarinique, intoxication, Brodifacoum.
How to Cite this Article
Wafa Masri, Ines Belwaer, Nozha Brahmi, Abderrazak Hedhili, and Mouldi Amamou, “Poisoning by Brodifacoum,” International Journal of Innovation and Scientific Research, vol. 20, no. 2, pp. 327–332, February 2016.
