Ingels Marianne, Lai Chi, Tai Winnie, Manning Beth H, Rangan Cyrus, Williams Saralyn R, Manoguerra Anthony S, Albertson Timothy, Clark Richard F
California Poison Control System, San Diego Division, San Diego, CA, USA.
Ann Emerg Med. 2002 Jul;40(1):73-8. doi: 10.1067/mem.2002.125449.
We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K.
We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded. Forty-eight- to 96-hour prothrombin time or international normalized ratio (INR) blood tests were recommended, and telephone contact was attempted at least 3 days after ingestion.
A total of 595 consecutive patients were enrolled during the 16-month study period. Fifty patients were excluded: 8 who were known to have ingested 1 pellet or less; 25 who received activated charcoal; 15 who were treated with induced emesis; and 2 who received prophylactic vitamin K. The resulting study group contained 545 patients. Eighty-two patients were lost to follow-up. Follow-up was obtained for 463 patients, including 222 by telephone contact alone, 62 by 48- to 96-hour INR, and 179 by both methods. None of the patients had clinically important coagulopathy. Two patients had an INR of 1.5 or greater (1.5 and 1.8) without symptoms. Single nosebleeds were reported in another 2 patients with normal 48-hour INRs. Another child had a small amount of blood crusted in the nose with no other symptoms and no laboratory work available. One child with a normal 48-hour INR had blood-streaked stools that were thought to be caused by an anal fissure.
Children with acute unintentional superwarfarin ingestions of less than 1 box may be managed without gastric decontamination or prophylactic vitamin K. Laboratory testing for coagulopathy should be reserved for cases involving clinically evident bleeding abnormalities.
我们确定未接受胃肠道去污或预防性维生素K治疗的摄入超华法林灭鼠剂儿童发生具有临床意义出血的发生率。
我们前瞻性地研究了6岁以下因急性意外摄入超华法林而到我们中毒控制中心就诊的患者。接受胃肠道去污或预防性维生素K的患者被排除。建议进行48至96小时的凝血酶原时间或国际标准化比值（INR）血液检测，并在摄入后至少3天尝试电话联系。
在16个月的研究期间，共纳入595例连续患者。50例患者被排除：8例已知摄入1粒或更少；25例接受了活性炭治疗；15例接受了催吐治疗；2例接受了预防性维生素K治疗。最终的研究组包括545例患者。82例患者失访。对463例患者进行了随访，其中仅通过电话联系随访222例，通过48至96小时INR随访62例，两种方法均随访179例。所有患者均无具有临床意义的凝血病。2例患者INR为1.5或更高（1.5和1.8），但无症状。另外2例48小时INR正常的患者报告有单次鼻出血。另一名儿童鼻子上有少量血痂，无其他症状且未进行实验室检查。一名48小时INR正常的儿童有带血丝的大便，被认为是由肛裂引起的。
急性意外摄入少于1盒超华法林的儿童无需进行胃去污或预防性维生素K治疗。对于涉及临床明显出血异常的病例，应进行凝血病的实验室检测。
