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Spontaneous haemoperitoneum from surreptitious ingestion of a rodenticide
L Soubiron1, P Hantson, I Michaux
1Department of Intensive Care, Cliniques Universitaires St-Luc, Brussels, Belgium.
Abstract:
Superwarfarins have progressively replaced warfarin as rodenticides as they are more potent and have a longer anticoagulant activity. Human exposure may be complicated by spontaneous haemorrhage in various sites. We report the case of a 51-year-old woman who was admitted with spontaneous haemoperitoneum and intramural haematoma along the small intestine. After the evidence of a deficit of vitamin K1-dependent clotting factors (II, VII, IX, X), the patient admitted that she was chronically ingesting difenacoum. She was successfully treated with fresh frozen plasma and vitamin K1. Follow-up was not accepted.
Insights
Superwarfarins like difenacoum are potent rodenticides causing bleeding in humans. Chronic ingestion led to a woman
Area of Science:
- Toxicology
- Hematology
- Internal Medicine
Background:
- Superwarfarins, potent rodenticides, are increasingly used over warfarin due to higher efficacy and prolonged anticoagulant effects.
- Human exposure to superwarfarins can lead to severe spontaneous hemorrhages.
- Difenacoum is a common superwarfarin rodenticide with significant anticoagulant properties.
Observation:
- A 51-year-old woman presented with spontaneous hemoperitoneum and an intramural hematoma in the small intestine.
- Clinical presentation suggested a coagulopathy involving vitamin K1-dependent clotting factors.
- The patient confessed to chronic ingestion of difenacoum.
Findings:
- Laboratory tests revealed a deficit in vitamin K1-dependent clotting factors (II, VII, IX, X).
- The patient's condition was directly linked to chronic difenacoum ingestion.
- Successful treatment involved the administration of fresh frozen plasma and vitamin K1.
Implications:
- This case highlights the risk of severe internal bleeding from chronic superwarfarin rodenticide ingestion.
- Prompt diagnosis and treatment with vitamin K1 and blood products are crucial for managing superwarfarin toxicity.
- Awareness among healthcare providers regarding superwarfarin poisoning is essential for timely intervention.