Unmet clinical laboratory need in patients hospitalized for acute poisoning from long-acting anticoagulant rodenticides

The importance of real-time, quantitative toxicology data available for physicians treating poisoned patients was illustrated during the 2018 outbreak in Illinois of severe coagulopathy caused by inhaling illicit synthetic cannabinoids products contaminated with commercially-available brodifacoum, d...

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Bibliographic Details
Published in:Toxicology communications 2021-01, Vol.5 (1), p.93-96
Main Authors: van Breemen, Richard B., Hafner, John W., Nosal, Daniel G., Feinstein, Douglas L., Rubinstein, Israel
Format: Article
Language:English
Subjects:
Anticoagulants
bleeding
blood transfusion
Cannabinoids
clotting factor concentrate
INR
Laboratories
Liquid chromatography
Mass spectroscopy
Patients
Plasma
Rodenticides
synthetic cannabinoids
Toxicology
vitamin K1
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Summary:The importance of real-time, quantitative toxicology data available for physicians treating poisoned patients was illustrated during the 2018 outbreak in Illinois of severe coagulopathy caused by inhaling illicit synthetic cannabinoids products contaminated with commercially-available brodifacoum, difenacoum, and bromadiolone, three potent, long-acting anticoagulant rodenticides (LAARs). Identification and quantification of these life-threatening toxins in blood samples of hospitalized patients required toxicology testing with liquid chromatography-tandem mass spectrometry (LC-MS/MS) that was not available in clinical laboratories of hospitals at the time of the outbreak. This highly-sensitive, quantitative assay can provide critical information to guide patient care during and after hospitalization, including identification of offending LAARs, estimates of the ingested dose, and dosage and discontinuation of oral vitamin K 1 therapy after hospital discharge once plasma LAARs concentrations decreased to a safe level (
ISSN:2473-4306
2473-4306
DOI:10.1080/24734306.2021.1925444