Clinical analysis of children with anticoagulant rodenticide poisoning

doi:10.3877/cma.j.issn.1673-5250.2017.06.017

Objective

To investigate clinical characteristics, diagnosis and treatment of children with anticoagulant rodenticide poisoning.

Methods

From January 2013 to December 2015, a total of 50 children with anticoagulant rodenticide poisoning who were admitted to Guizhou Provincial People′s Hospital were enrolled into this study by retrospective method. Their ages ranged from 2-month-old to 12-year old. The following items were observed. ① Basic information, including the onset of anticoagulant rodenticide poisoning, gender, age, origin, occurrence season, toxic exposure of anticoagulant rodenticide poisoning and clinical manifestations were analyzed. ②Laboratory examinations, including routine blood test, blood coagulation, coagulation factor activity, serum toxicology examination, liver and renal function, myocardial enzymes were detected. ③ The diagnosis, course of disease and prognosis were analyzed. Furthermore, the prothrombin time (PT) and activated partial thromboplastin time (APTT) before and after the vitamin K1 treatment were statistically analyzed. The procedures followed in this study were in line with the ethical standards set by Ethical Review Board of Investigation in Human Beings of Guizhou Provincial People′s Hospital and were approved by the committee.

Results

① Among those 50 cases, 6 cases (12.0%, 6/50) came from city and 44 cases (88.0%, 44/50) came from countryside. Among the 44 cases from countryside, 18 cases (40.9%, 18/44) were left-behind children. ② The high-occurrence seasons of anticoagulant rodenticide poisoning were spring and autumn, accounted for 30.0% (15/50) and 28.0% (14/50), respectively. ③ Among those 50 cases, 17 cases (34.0%, 17/50) had toxic exposure of anticoagulant rodenticide poisoning, 6 cases (12.0%, 6/50) had suspicious toxic exposure of anticoagulant rodenticide poisoning, and 27 cases (54.0%, 27/50) denied toxic exposure of anticoagulant rodenticide poisoning. ④ The main clinical manifestations were mucocutaneous hemorrhage (50.0%, 25/50), as well as arthrodynia, myalgia, ecchymosis, alimentary tract hemorrhage, and so on. ⑤ A total of 37 cases received serum toxicology examination. The results revealed that 26 cases (70.3%, 26/37) were detected simple brodifacoum poisoning, 5 cases (13.5%, 5/37) were detected simple bromadiolone poisoning, and 6 cases (16.2%, 6/37) were detected both brodifacoum and bromadiolone poisoning. And brodifacoum concentration ranged from 42 ng/mL to 3 096 ng/mL among 32 cases with brodifacoum poisoning, bromadiolone concentration ranged from 5 ng/mL to 767 ng/mL among 11 cases with bromadiolone poisoning. ⑥ There were statistically significant differences in the aspects of PT, APTT before and after the vitamin K1 treatment among those 50 cases (Z=-6.093, -6.093; P<0.001).

Conclusions

The vitamin K1 is an effective treatment for anticoagulant rodenticide poisoning. Clinicians should make the individualized treatment of vitamin K1 for the children with anticoagulant rodenticide poisoning based on the results of serum toxicology examination and blood coagulation detection, and the period of vitamin K1 treatment should more than 2-3 months.

Key words: Poisoning, Anticoagulant rodenticide, Vitamin K1, Child

表1 50例不同性别抗凝血灭鼠药中毒患儿在不同年龄段分布情况[例数(%)]

性别	例数	<1岁	≥1～8岁	≥8～10岁	≥10岁
男	32	2(6.3)	24(75.0)	4(12.5)	2(6.3)
女	18	0(0)	13(72.2)	1(5.6)	4(22.2)
合计	50	2(4.0)	37(74.0)	5(10.0)	6(12.0)

表1 50例不同性别抗凝血灭鼠药中毒患儿在不同年龄段分布情况[例数(%)]

性别	例数	<1岁	≥1～8岁	≥8～10岁	≥10岁
男	32	2(6.3)	24(75.0)	4(12.5)	2(6.3)
女	18	0(0)	13(72.2)	1(5.6)	4(22.2)
合计	50	2(4.0)	37(74.0)	5(10.0)	6(12.0)

表2 50例抗凝血灭鼠药中毒患儿的临床表现、病程及住院次数情况[例数(%)]

项目		构成比或发生率	项目		构成比或发生率
临床表现		?	病程(d)		?
?	皮肤黏膜出血	25(50.0)	?	<7	1(2.0)
?	关节、肌肉疼痛	9(18.0)	?	≥7～21	39(78.0)
?	皮下血肿	6(12.0)	?	≥21～90	10(20.0)
?	消化道出血	6(12.0)	住院次数(次)		?
?	颅内出血	3(6.0)	?	1	48(96.0)
?	泌尿道出血	1(2.0)	?	2	1(2.0)
?	继发性癫痫	2(4.0)	?	3	1(2.0)

表2 50例抗凝血灭鼠药中毒患儿的临床表现、病程及住院次数情况[例数(%)]

项目		构成比或发生率	项目		构成比或发生率
临床表现		?	病程(d)		?
?	皮肤黏膜出血	25(50.0)	?	<7	1(2.0)
?	关节、肌肉疼痛	9(18.0)	?	≥7～21	39(78.0)
?	皮下血肿	6(12.0)	?	≥21～90	10(20.0)
?	消化道出血	6(12.0)	住院次数(次)		?
?	颅内出血	3(6.0)	?	1	48(96.0)
?	泌尿道出血	1(2.0)	?	2	1(2.0)
?	继发性癫痫	2(4.0)	?	3	1(2.0)

表3 50例抗凝血灭鼠药中毒患儿接受维生素K1治疗前及治疗后PT和APTT比较结果[s，M(P₂₅～P₇₅)]

项目	PT	APTT
治疗前	23.4(21.4～28.4)	146.0(93.6～>180.0)
治疗后	12.7(11.7～13.4)	180.0(84.2～>180.0)
Z值	－6.093	－6.093
P值	<0.001	<0.001

表3 50例抗凝血灭鼠药中毒患儿接受维生素K1治疗前及治疗后PT和APTT比较结果[s，M(P₂₅～P₇₅)]

项目	PT	APTT
治疗前	23.4(21.4～28.4)	146.0(93.6～>180.0)
治疗后	12.7(11.7～13.4)	180.0(84.2～>180.0)
Z值	－6.093	－6.093
P值	<0.001	<0.001

[1]	向伟，丁宗一. 儿童意外伤害的预防及措施[J]. 中华儿科杂志，2003，41(11): 876-879.
[2]	胡兴强，刘红. 安徽省2005年毒鼠强中毒事件流行病学分析[J]. 中华卫生杀虫药械，2008，14(6): 477-479.
[3]	芮耀诚．现代药物学[M]．北京：人民军医出版社，1999：1351-1352.
[4]	唐玲玲，徐酉华. 抗凝血灭鼠药中毒的研究现状[J]. 儿科药学杂志，2012，18(1)：56-59.
[5]	邱泽武，彭晓波. 重视抗凝血杀鼠剂中毒，全面提高临床诊治水平[J]. 中华急诊医学杂志，2014，23(11): 1189-1191.
[6]	杨发俊，周洁，刀敏，等. 15例敌鼠钠二次中毒临床分析[J]. 中外健康文摘，2011, 8(6): 226-227.
[7]	Dituri F, Buonocore G, Pietravalle A, et al. PIVKA-Ⅱ plasma levels as markers of subclinical vitamin K deficiency in term infants [J]. J Matern Fetal Neonatal Med, 2012, 25(9): 1660-1663.
[8]	Olmos V, López CM. Brodifacoum poisoning with toxicokinetic data [J]. Clin Toxicol (Phila), 2007, 45(5): 487-489.
[9]	Caravati EM, Erdman AR, Scharman EJ, et al. Long-acting anticoagulant rodenticide poisoning: an evidence-based consensus guideline for out-of-hospital management [J]. Clin Toxicol (Phila), 2007, 45(1): 1-22.
[10]	Rishavy MA, Usubalieva A, Hallgren KW, et al. Novel insight into the mechanism of the vitamin K oxidoreductase (VKOR): electron relay through Cys43 and Cys51 reduces VKOR to allow vitamin K reduction and facilitation of vitamin K-dependent protein carboxylation [J]. J Biol Chem, 2011, 286(9): 7267-7278.
[11]	Gong IY, Schwarz UI, Crown N, et al. Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation [J]. PLoS One, 2011, 6(11): e27808.
[12]	Weitzel JN, Sadowski JA, Furie BC, et al. Surreptitious ingestion of a long-acting vitamin K antagonist/rodenticide, brodifacoum: clinical and metabolic studies of three cases [J]. Blood, 1990, 76(12): 2555-2559.
[13]	Sarin S, Mukhtar H, Mirza MA. Prolonged coagulopathy related to superwarfarin overdose [J]. Ann Intern Med, 2005, 142(2): 156.
[14]	李鹏，张称心，毕小朵，等. 维生素K1联合输注血浆抢救小儿溴鼠灵中毒一例[J]. 中国小儿急救医学，2012, 19(1): 105-106.
[15]	高丽丹，杨红军，陈芝. 血液灌流救治一例危重溴敌隆中毒患者报告[J]. 中国疗养医学，2011, 20(2): 169-170.
[16]	刘雅东，刘刚. 血液灌流在急性溴敌隆中毒中的应用[J]. 河北医学，2012, 18(12): 1726-1728.

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