Devgun Jason M, Rasin Arkady, Kim Theresa, Mycyk Mark B, Bryant Sean M, Wahl Michael S, DesLauriers Carol, Navon Livia, Moritz Erin D, Thompson Trevonne M, Swoboda Henry D, Lu Jenny, Aks Steven E
Toxikon Consortium, Chicago, IL, USA.
Department of Emergency Medicine, Division of Medical Toxicology, Cook County Health, Chicago, IL, USA.
Clin Toxicol (Phila). 2020 Aug;58(8):821-828. doi: 10.1080/15563650.2019.1690149. Epub 2019 Dec 4.
To describe a large regional poison center's experience managing an outbreak of long-acting anticoagulant rodenticide (LAAR) poisoning associated with synthetic cannabinoid (SC) use. This is a retrospective review of exposures reported to the Illinois Poison Center between March 10 and August 1, 2018. All cases coded as exposure to Δ9-tetrahydrocannabinol homologs were identified. Patients with suspected SC use, positive LAAR testing, and coagulopathy (signs or symptoms of bleeding or international normalized ratio [INR] > 2) were included. If confirmatory LAAR testing was performed and resulted as negative, the patient was excluded from this analysis. In the absence of LAAR testing, patients with suspected SC use, an INR >2, and no alternative explanation of coagulopathy were included. Suspected SC use was defined as use suspected by a member of the treating team or reported by the patient. Presenting signs and symptoms, laboratory findings, management, healthcare utilization, outcomes, and disposition of patients affected by this outbreak were reported. One hundred seventy-eight cases met inclusion criteria. Most patients were male (73%) and young to middle-aged (median age 32, IQR 25-40). Most presented to hospitals in Peoria (35%) and Cook (31%) counties. Median hospitalization was three days (IQR 2-4). Eighty-eight percent of patients presented with an INR >10. Eighteen cases had qualitative anticoagulant testing, all of which were positive for brodifacoum. Other identified LAARs included difenacoum (10/18) and bromadiolone (1/18). Sixty-three percent of patients had back, flank or abdominal pain; 70% of patients presented with hematuria. One hundred six cases received IV vitamin K; no adverse or anaphylactoid reactions were reported. Forty-one (22%) patients left AMA. Thirty-eight patients (21%) were re-hospitalized during the study period. Patients leaving AMA were 1.6 times more likely to be re-hospitalized than patients with other dispositions. Intracranial hemorrhage, present in 3% of total cases, was present in 4 of 5 fatalities. We describe an outbreak of multiple LAARs contaminating SCs. Patients presented with bleeding from varied sites, often required blood products, factor replacement, and high dose vitamin K for stabilization.
描述一家大型地区中毒控制中心处理与合成大麻素（SC）使用相关的长效抗凝血灭鼠剂（LAAR）中毒事件的经验。这是一项对2018年3月10日至8月1日向伊利诺伊州中毒控制中心报告的暴露病例的回顾性研究。识别所有编码为暴露于Δ9 - 四氢大麻酚同系物的病例。纳入疑似使用SC、LAAR检测呈阳性且患有凝血病（出血的体征或症状或国际标准化比值[INR]＞2）的患者。如果进行了LAAR确诊检测且结果为阴性，则该患者被排除在本分析之外。在未进行LAAR检测的情况下，纳入疑似使用SC、INR＞2且无凝血病其他解释的患者。疑似使用SC的定义为治疗团队成员怀疑或患者报告的使用情况。报告了此次中毒事件中受影响患者的临床表现、实验室检查结果、治疗、医疗资源利用、结局及处置情况。178例病例符合纳入标准。大多数患者为男性（73%），年龄在青年至中年之间（中位年龄32岁，四分位间距25 - 40岁）。大多数患者前往皮奥里亚县（35%）和库克县（31%）的医院就诊。中位住院时间为3天（四分位间距2 - 4天）。88%的患者INR＞10。18例患者进行了定性抗凝血检测，所有结果均显示溴敌隆阳性。其他鉴定出的LAAR包括敌鼠（10/18）和溴鼠灵（1/18）。63%的患者有背部、侧腹或腹痛；70%的患者出现血尿。106例患者接受了静脉注射维生素K；未报告不良或类过敏反应。41例（22%）患者自动出院。38例患者（21%）在研究期间再次住院。自动出院的患者再次住院的可能性是其他处置方式患者的1.6倍。颅内出血占总病例数的3%，在5例死亡病例中有4例出现。我们描述了一起多种LAAR污染SC的中毒事件。患者出现不同部位出血，常需血液制品、凝血因子替代治疗及大剂量维生素K来稳定病情。
