Coumarin Plant Poisoning Clinical Presentation

  • Author: Arasi Thangavelu, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 30, 2012
 

History

  • Elicit a history of exposure to medicinal hydroxycoumarins or rodenticides.
  • History may be difficult to obtain from patients who have ingested hydroxycoumarin products surreptitiously or with suicidal intent.
  • Ask the following questions to ascertain specific history:
    • Was ingestion a pharmaceutical or a long-acting rodenticide preparation?
    • Was ingestion intentional or unintentional? (Single unintentional ingestions of warfarin and warfarin-containing rodenticides usually are harmless; however, intentional and large unintentional ingestions of pharmaceutical-grade anticoagulants or rodenticides can produce life-threatening bleeding.)
    • How much was ingested?
    • When did the ingestion occur?
    • Was the ingestion a single acute ingestion or a chronic ingestion?
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Physical

Bleeding diathesis does not occur until 24 hours postingestion. Continued re-evaluation for signs of coagulopathy is necessary.

Complications of excessive anticoagulation may occur. Initially, assessment of hemodynamic status and neurologic status are most important.

  • Excessive ecchymosis, gangrene, and skin necrosis
  • Purpura
  • Subconjunctival hemorrhage
  • Bleeding gums
  • Epistaxis
  • Menorrhagia
  • Gross hematuria
  • Hematomas
  • Compartment syndromes
  • Immediately life-threatening hemorrhage
    • Massive GI bleeding (eg, hematemesis, melena)
    • Intracranial hemorrhage
    • Upper airway compromise due to expanding hematoma
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Causes

Warfarin anticoagulants and the anticoagulant rodenticides (Human toxicity from ingestion of plants and herbal medications is extremely rare.)

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Contributor Information and Disclosures
Author

Arasi Thangavelu, MD  Consulting Staff, Department of Emergency Medicine, Phoebe Putney Memorial Hospital

Arasi Thangavelu, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Coauthor(s)

Lisandro Irizarry, MD, MPH, FAAEM  Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine

Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

B Zane Horowitz, MD, FACMT  Professor, Department of Emergency Medicine, Oregon Health and Sciences University; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Medical Toxicology

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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