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Acute Pediatric Warfarin (Coumadin) Ingestion: Toxic Effects Despite Early Treatment

Acute Pediatric Warfarin (Coumadin) Ingestion: Toxic Effects Despite Early Treatment Abstract Sir.—National data from the American Association of Poison Control Centers1 indicate that children frequently ingest warfarin anticoagulants. In 1991, a total of 683 cases of warfarin anticoagulant (pharmaceutical, excluding rodenticides) exposures were referred to participating poison centers. However, cases of toxic effects following single acute ingestions of warfarin sodium (Coumadin) by children have apparently not been reported. The patient described herein is unusual in that the child became moderately anticoagulated after a single ingestion of warfarin, despite early treatment with both gastrointestinal decontamination and phytonadione. The report emphasizes the need for monitoring prothrombin times (PTs) in instances of large acute ingestions by children. Patient Report.—A 20-month-old, 11.3-kg boy was seen in a local emergency department after ingesting nine to ten 5-mg tablets of warfarin sodium (about 4 mg/kg) 20 minutes earlier. By counting the number of tablets prescribed and those missing, the history was believed to be References 1. Litovitz TL, Holm KC, Bailey KM. 1991 Annual report of the American Association of Poison Control Centers National Data Collection System . Am J Emerg Med . 1992;10:452-505.Crossref 2. Kumer K, Nwangwu PV. Clinical toxicology of warfarin from commercial rodenticides: symptoms, diagnosis and management . Clin Toxicol Consult . 1981;3:23-27. 3. O'Reilly RA. Anticoagulant, antithrombotic and thrombolytic drugs . In: Gilman A, Goodman L, Rall T, Murad F, eds. The Pharmacologic Basis of Therapeutics . New York, NY: MacMillan Publishing Co Inc; 1985:1338-1359. 4. Coumadin. Wilmington, Del: Du Pont Pharmaceuticals; 1987. Product information. 5. Rumack BH, ed. Warfarin (Management/Treatment Protocol) in Poisindex Information System . Denver, Colo: Micromedex Inc; 1990. 6. Carpentieri U, Ngheim QX, Harris LC. Clinical experience with an oral anticoagulant in children . Arch Dis Child . 1976;51:445-448.Crossref 7. Ellenhorn MJ, Barceloux DG. Medical Toxicology, Diagnosis and Treatment of Human Poisoning . New York, NY: Elsevier Science Publishing Co Inc; 1988:209-228. 8. Martin-Bouyer G, Linh PD, Tuan LC, et al. Epidemic of hemorrhagic disease in Vietnamese infants caused by warfarin-contaminated talcs . Lancet . 1983;1:230.Crossref 9. Green P. Hemorrhagic diathesis attributed to 'warfarin' poisoning . Can Med Assoc J . 1955; 72:769-770. 10. Mogilner BM, Freeman JS, Blashar Y, Pincus FE. Reye's syndrome in three Israeli children: possible relationship to warfarin toxicity . Isr J Med Sci . 1974;10:1117-1125. 11. McCurdy W. An attempted homicide using d-Con rat poison . J Anal Toxicol . 1988;12: 51-52.Crossref 12. Hackett LP, Ilett KF, Chester A. Plasma warfarin concentrations after a massive overdose . Med J Aust . 1985;142:642-643. 13. Schuh A, Keating A. Anticoagulants . In: Haddad L, Winchester J, eds. Clinical Management of Poisoning and Drug Overdose . Philadelphia, Pa: WB Saunders Co; 1990:307-320. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Acute Pediatric Warfarin (Coumadin) Ingestion: Toxic Effects Despite Early Treatment

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160300015007
Publisher site
See Article on Publisher Site

Abstract

Abstract Sir.—National data from the American Association of Poison Control Centers1 indicate that children frequently ingest warfarin anticoagulants. In 1991, a total of 683 cases of warfarin anticoagulant (pharmaceutical, excluding rodenticides) exposures were referred to participating poison centers. However, cases of toxic effects following single acute ingestions of warfarin sodium (Coumadin) by children have apparently not been reported. The patient described herein is unusual in that the child became moderately anticoagulated after a single ingestion of warfarin, despite early treatment with both gastrointestinal decontamination and phytonadione. The report emphasizes the need for monitoring prothrombin times (PTs) in instances of large acute ingestions by children. Patient Report.—A 20-month-old, 11.3-kg boy was seen in a local emergency department after ingesting nine to ten 5-mg tablets of warfarin sodium (about 4 mg/kg) 20 minutes earlier. By counting the number of tablets prescribed and those missing, the history was believed to be References 1. Litovitz TL, Holm KC, Bailey KM. 1991 Annual report of the American Association of Poison Control Centers National Data Collection System . Am J Emerg Med . 1992;10:452-505.Crossref 2. Kumer K, Nwangwu PV. Clinical toxicology of warfarin from commercial rodenticides: symptoms, diagnosis and management . Clin Toxicol Consult . 1981;3:23-27. 3. O'Reilly RA. Anticoagulant, antithrombotic and thrombolytic drugs . In: Gilman A, Goodman L, Rall T, Murad F, eds. The Pharmacologic Basis of Therapeutics . New York, NY: MacMillan Publishing Co Inc; 1985:1338-1359. 4. Coumadin. Wilmington, Del: Du Pont Pharmaceuticals; 1987. Product information. 5. Rumack BH, ed. Warfarin (Management/Treatment Protocol) in Poisindex Information System . Denver, Colo: Micromedex Inc; 1990. 6. Carpentieri U, Ngheim QX, Harris LC. Clinical experience with an oral anticoagulant in children . Arch Dis Child . 1976;51:445-448.Crossref 7. Ellenhorn MJ, Barceloux DG. Medical Toxicology, Diagnosis and Treatment of Human Poisoning . New York, NY: Elsevier Science Publishing Co Inc; 1988:209-228. 8. Martin-Bouyer G, Linh PD, Tuan LC, et al. Epidemic of hemorrhagic disease in Vietnamese infants caused by warfarin-contaminated talcs . Lancet . 1983;1:230.Crossref 9. Green P. Hemorrhagic diathesis attributed to 'warfarin' poisoning . Can Med Assoc J . 1955; 72:769-770. 10. Mogilner BM, Freeman JS, Blashar Y, Pincus FE. Reye's syndrome in three Israeli children: possible relationship to warfarin toxicity . Isr J Med Sci . 1974;10:1117-1125. 11. McCurdy W. An attempted homicide using d-Con rat poison . J Anal Toxicol . 1988;12: 51-52.Crossref 12. Hackett LP, Ilett KF, Chester A. Plasma warfarin concentrations after a massive overdose . Med J Aust . 1985;142:642-643. 13. Schuh A, Keating A. Anticoagulants . In: Haddad L, Winchester J, eds. Clinical Management of Poisoning and Drug Overdose . Philadelphia, Pa: WB Saunders Co; 1990:307-320.

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jun 1, 1993

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