Possible unaware intoxication by anticoagulant rodenticide

Area of Science:

• Toxicology
• Pharmacology
• Hematology

Background:

• Superwarfarin rodenticides pose a significant risk for accidental poisoning.
• Diagnosis can be challenging due to lack of patient history regarding anticoagulant exposure.

Observation:

• A patient presented with generalized ecchymosis and a normal medical and drug history.
• The patient had elevated international normalized ratio and reduced vitamin K-dependent coagulation factors.
• Hematologic and liver function tests were within normal limits.

Findings:

• A thorough clinical history revealed the patient's unaware exposure to anticoagulant rodenticides in his environment.
• The patient's dementia may have contributed to the lack of awareness regarding rodenticide exposure.

Implications:

• This case highlights the importance of considering environmental exposures, like rodenticides, in unexplained bleeding diathesis.
• Enhanced clinical pharmacist involvement in patient history taking can uncover crucial diagnostic information.
• Increased awareness and suspicion for superwarfarin toxicity are vital for timely diagnosis and management.