Physical Examination V/S: T 36.6 ° C, PR 126/min, BP 98/53 mmHg, RR 32/min BW 9.5 kg, Ht. 77 cm %W/A 95, %W/A 95, %H/A 100%, Nutritional status: normal GA: a Thai male toddler, crying HEENT: no pale conjunctiva, no icteric sclera, no sunken eye ball, mildly dry lips, no injected pharynx and tonsil, no wound at oral mucosa, intact TM both ears
Physical Examination Heart: normal S1S2, no murmur Lung: clear, equal breath sound both lungs Abdomen: soft, not tender, liver and spleen are impalpable Extremities: no deformities, pulse-full, capillary refill < 2 sec Skin: no rash, no bruise, no ecchymosis Neurological examination: normal
Problem list History of suspected Rodenticide ingestion – Brodifacoum Acute gastritis with mild dehydration
Management โทรศัพท์ถามที่ศูนย์พิษรามา๚ ABC On IV fluid Lab investigation Observe clinical: GI irritation, Bleeding
Progression วันที่ InvestigationManagement 12 ส. ค. 53 Coagulogram: PT 11.5, PTT 31, INR 0.99 NPO On IV fluid Observe clinical Vitamin K 5 mg IV x I 13 ส. ค. 53 Coagulogram: PT 12.5, PTT 32.3, INR 1.0 discharge
Brodifacoum poisoning it is characterised as a "second generation" or "superwarfarin" anticoagulant. very high potency and long duration of action (elimination half-life of 20 – 130 days) Brodifacoum inhibits the enzyme Vitamin K epoxide reductase. – decreases the level of active vitamin K in the blood – Interfere production of VitK clotting factor In toxic dose – increase permeability of capillaries
Brodifacoum poisoning Symptoms and sign Coagulation disturbance may become evident after a period of days No specific GI symptom Asymptomatic or no clinical sign of abnormal bleeding Symptomatic with evidence of abnormal bleeding From animal experiment, the amount required to depress PT is about 1.5 mg for a child wt. 10 kg. Treatment antidote to brodifacoum poisoning is vitamin K1 If unabsorbed poison is still in the digestive system, gastric lavage followed by administration of activated charcoal may be required. Administration of vitamin C may be useful as an adjunct phenobarbital-accelerate the metabolism of some anticoagulantsvia enzyme induction.