A 5 year old male with no previous medical history is brought to the ER by his mother because he accidentally ingested a large dose of rat poison. He is conscious but appears quite agitated. On physical exam, he is found to have a blood pressure of 110/70 and a hea rate of 90. Labs are significant for an elevated PT but a normal PTT. The patient should be immediately treated with?
As you might have guessed from his elevated PT level, the active ingredient in rat poison is warfarin. It acts as an anticoagulant by interfering with the normal hepatic synthesis of the vitamin K-dependent clotting factors II, VII, IX, and X. The most impoant adverse effect of warfarin is bleeding. The action of warfarin can be reversed with vitamin K. Atropine is used as an antidote for anticholinesterase toxicity (e.g., ingestion of organophosphates). Flumazenil is used as an antidote for benzodiazepine toxicity (e.g., Valium). N-acetylcysteine is used as an antidote for acetaminophen toxicity. Ref: Anderson I.B. (2012). Chapter 158. Warfarin and Related Rodenticides. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.
Atropine
Flumazenil
N-acetylcysteine
Vitamin K