| Objective Through the discussion and analysis of coagulopathy caused by anticoagulant rodenticide poisoning,to improve the experience and reference data of these diseases.Methods Retrospective analysis 110 cases of the second generation class anticoagulant rodenticide poisoning children with clinical data, laboratory examination, treatment and prognosis.Results 1.110 cases patients were all hospitalized because of the second generation class anticoagulant rodenticide poisoning. Sex ratio was 1.2:1. Rural distribution accounted for 78.18%(86/110).2.The age distribution ranged from one month 24 days to 15years 7months,with median age (85.44 ±54.82) months.3 cases of infancy group, 27 cases of early childhood group,23 cases of preschool group,21 cases of the school-age group,36 cases of puberty group. Adolescent age group accounts most.3.110 cases of 22 patients had a clear rat poison contacting history,35 cases of suspicion,53 cases of denial.The incubation period was about 2-14 days.4.The clinical manifestations of these patients were bleeding in skin and mucosa, subcutaneous tissue,organs.The bleeding time showed a total of 283 cases. Petechiae and ecchymoses accounted for 26.51%(75/283); and subcutaneous hematoma accounted for 24.38%(69/283);Epistaxis accounted for 20.49%(58/283); Gingival bleeding accounted for 17.67% (50/283);and urinary tract bleeding accounted for 5.65%(16/283); and gastrointestinal tract bleeding accounted for 3.53%(10/283);Intracranial bleeding accounted for 1.77%(5/283).5.This group of children with anemia accounted for 88.18%(97/110), the degree of anemia was associated with clinical severity of bleeding; Mild anemia accounted for 27.83%(27/97); Moderate anemia accounted for 50.52%(49/97);and severe anemia accounted for 18.56%(18/97); Extremely severe anemia accounted for 3.09%(3/97).6.All the patients were characterized by prolongation of PT,APTT and INR.TT was normal.33.64%(37/110) of patients had the rise of fibrinogen levels, with the median (3.97±0.38)g/L.50 cases checked on the clotting factors, with clotting factor II, VII, IX, X level decline.7.10 cases had liver dysfunction,4 cases had renal dysfunction,with the ALT median (103.77±54.28) U/L, the AST median (123.93±93.98) U/L.8.110 cases of rodenticide poisoning children underwent blood toxicology test,with 96 cases urine toxicology test.Only brodifacoum in the blood accounted for 67.27%(74/110),with the median concentration (420.99±615.16)ng/ml,only bromadiolone in the blood accounted for 14.55%(16/110),with the median concentration(236.44±212.18)ng/ml.Both two kinds of rat poison in the blood accounted for 18.18%(20/110),with brodifacoum median concentration (1250.10±1937.02)ng/ml, bromadiolone median concentration (344.35±848.48)ng/ml.9.The correlation between blood concentration of rat poison and clinical bleeding severity, clotting factor levels was not obvious.10.The difference manifestations between brodifacoum and bromadiolone were that the former was more easily bleeding especially in epistaxis(P=0.040).11.All patients were given special antidote vitamin Kl (10 mg-20 mg qd) treatment for 3 to 16 days.95.45%(105/110) of patients were given daily or every other day fresh frozen plasma,and cold precipitation or prothrombin complex to control the acute bleeding. The coagulation function change had statistic significance after 1 to 3 days.26.36%(29/110) of children returned to the hospital again because of bleeding again caused by the self-administered drug withdrawal.12.The analysis of the correlation between rat poison blood concentration and treatment course showed there may be a positive correlation between brodifacoum concentration and treatment, but the linear correlation degree was not strong.13.The patients successfully followed up accounted for 80.00% (88/110), while lost to follow-up rate was 20.00%(22/110). follow-up time was 1-48 months.79 cases recovered and the total treatment time 1 week to 18 months, with median treatment (3.03±3.29) months. Prognosis is good, without any sequelaes.Conclusion 1.The anticoagulant rodenticide poisoning occurred most in puberty ages because of the rebellious character. Regional distribution was concentrated in rural areas and we should strengthen the supervision of rural rat poison.2.The clinical manifestations of these patients were bleeding in skin and mucosa, subcutaneous tissue,organs.Patients often had anemia.Some patients had liver or renal dysfunction because of the rat poison acute toxicity.All the patients were characterized by prolongation of PT,APTT and INR.TT was normal.The rise of some Fib may be associated with stress reaction.Clotting factor II, VII, IX, X level was declined.3.The correlation between blood concentration of rat poison and clinical bleeding severity, clotting factor levels was not obvious because of the small sample size.There needs multi-center large sample size to further confirm.4. The difference manifestations between brodifacoum and bromadiolone were that the former was more easily bleeding especially in epistaxis,because of the different LD50.5.The special antidote of anticoagulant rodenticide poisoning preferred vitamin Kl.The dosage and course had no uniform standard.The course of treatment may be associated with rat poison concentration and individual difference of gene,so the principle of individualized treatment is needed. Suggestions for medicine were at least more than 10 mg/day, and treatment time at least 3 months, reducing dose according to clinical manifestations and blood coagulation function recovery. |
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