COMBINED SUPERWARFARIN AND ETHYLENE-GLYCOL INGESTION - A UNIQUE CASE-REPORT WITH MISLEADING CLINICAL HISTORY

A markedly elevated prothrombin time (PT) and activated partial thromb oplastin time (APTT) were observed in a 24-year-old man who was admitt ed with a history of ethylene glycol ingestion. Further laboratory eva luation suggested that the coagulopathy was related to acquired factor deficiencies. The PT and APTT improved transiently on usual doses of vitamin K, but rapidly became abnormal again. The coagulopathy was con trolled only after large doses of vitamin K for at least 37 days. On f urther questioning, the patient admitted to consuming a large quantity of a rodenticide. The second generation anticoagulant rodenticides (s uperwarfarins) result in a potent and prolonged anticoagulant effect b y reducing the activity of the vitamin K dependent factors (II, XII, I X, and X). To our knowledge, this is the first reported concomitant in gestion of both ethylene glycol and a superwarfarin compound. This cas e serves to illustrate how a logical laboratory evaluation can lead to the proper diagnosis, despite a misleading clinical history.