Treatment of brodifacoum overdose with prothrombin complex concentrate

Abstract

Purpose: A case of brodifacoum overdose and its treatment with prothrombin complex concentrate (PCC) are reported. Summary: A 44-year-old Caucasian woman weighing 62 kg arrived at the emergency department with a chief complaint of lower left leg pain for two days. A computed tomography (CT) scan of the abdomen revealed perihepatic fuid collection (likely a hematoma), a smallbowel intramural hematoma, and blood in the paracolic gutter. A CT scan of the patient's left foot showed soft tissue swelling without evidence of fracture or dislocation. The patient was diagnosed with left extremity compartment syndrome secondary to hematoma and trauma. The patient had a history of depression and anxiety and eventually admitted to ingesting large doses of brodifacoum the week prior with suicidal intentions. The patient was treated with phytonadione 20 mg i.v., 1 unit of fresh frozen plasma (FFP), and 1 unit of packed red blood cells. Laboratory test values measured in the intensive care unit revealed an International Normalized Ratio (INR) of 15, a prothrombin time of >120 seconds, and a partial prothromboplastin time of >180 seconds. After consulting with a local poison center, phytonadione 50 mg i.v., PCC 3100 units, and 4 units of FFP were immediately administered to reverse the patient's coagulopathy. The dose of oral phytonadione was lowered based on INR stability. Once the coagulopathy was stabilized, the patient was transferred to an inpatient psychiatric facility on phytonadione 10 mg daily orally to maintain a stable INR. Conclusion: A 44-year-old woman who intentionally ingested brodifacoum was successfully treated with phytonadione, PCC, and FFP.