Case 101 – summary

This is a case of super warfarin overdose. It was complicated by the lack of accurate history from the patient due to presentation with an intra cranial haemorrhage.

Super warfarin are easily available as rodenticides. The most common in the UK are difenacoum, bromodialone and brodifacoum. All have long half lives. In the case of difenacoum, it’s half life in the plasma is approximately 20 days and 60 days in tissue.

Frequently many months of daily treatment with higher doses of vitamin K are required. Initially in this case daily intravenous doses of 50 – 100 mg are likely to be needed, followed by many months of 100mg a day orally.

Suggestions for further reading:

Card, D.J., Francis, S., Deuchande, K. and Harrington, D.J., 2014. Case Report: Superwarfarin poisoning and its management. BMJ case reports, 2014.

King, N. and Tran, M.H., 2015. Long-acting anticoagulant rodenticide (superwarfarin) poisoning: a review of its historical development, epidemiology, and clinical management. Transfusion medicine reviews, 29(4), pp.250-258.

Spahr, J.E., Maul, J.S. and Rodgers, G.M., 2007. Superwarfarin poisoning: a report of two cases and review of the literature. American journal of hematology, 82(7), pp.656-660.

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