Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine (M/C 719), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.
Medical Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA.
Lung. 2019 Jun;197(3):349-352. doi: 10.1007/s00408-019-00227-2. Epub 2019 Apr 19.
A large-scale outbreak of life-threatening, inhaled synthetic cannabinoids (Spice/K2)-associated coagulopathy with bleeding complications was recently reported in Illinois. The causative agents were brodifacoum, difenacoum, and bromadiolone, potent, long-acting, 4-hydroxycoumarin anticoagulant rodenticides (LAAR) that were mixed with Spice/K2 products procured and then inhaled by the victims. We report on 3 poisoned patients who reside in underserved, socioeconomically disadvantaged neighborhoods of Chicago that were admitted and treated successfully at two inner-city, tertiary care hospitals in Chicago. The patients were discharged from the hospitals on daily long-term high-dose oral vitamin K (VK), provided free of charge. However, 2 patients were lost to follow-up prior to safe discontinuation of oral VK therapy. The third patient was treated and followed successfully for 7 months when VK was discontinued. We conclude that prolonged oral VK therapy and follow-up of acute, life-threatening LAAR poisoning are variable and present challenges to healthcare providers. Appropriate practice guidelines to improve patient access and adherence to daily high-dose oral VK therapy and follow-up should be developed and implemented.
最近，伊利诺伊州报告了一起大规模的危及生命、吸入合成大麻素（Spice/K2）相关凝血功能障碍伴出血并发症的爆发。致病剂为溴鼠灵、杀鼠灵和溴敌隆，这是混合在 Spice/K2 产品中的强效、长效、4-羟基香豆素抗凝血灭鼠剂（LAAR），这些产品被受害者购买并吸入。我们报告了 3 名居住在芝加哥服务不足、社会经济处于不利地位社区的中毒患者，他们在芝加哥的两家市内三级保健医院成功入院并接受治疗。这些患者在出院后每天服用长期大剂量口服维生素 K（VK），免费提供。然而，2 名患者在口服 VK 治疗安全停药前失去了随访。第三名患者在 VK 停药后成功治疗和随访了 7 个月。我们得出结论，延长口服 VK 治疗和急性、危及生命的 LAAR 中毒的随访时间是可变的，并对医疗保健提供者提出了挑战。应制定和实施适当的实践指南，以改善患者获得和遵守每日大剂量口服 VK 治疗和随访的机会。
