‘Rats! I’m High’

​A 24-year-old man presented with uncontrollable epistaxis. He said he had been bleeding "a ton" from his nose continuously for four hours. He denied recent trauma, and explained that this epistaxis was sudden onset. He had no past medical history, and denied previous episodes of excessive bleeding. An examination demonstrated no signs of trauma and was unremarkable aside from the epistaxis. His nostrils revealed no obvious bleeding vessels for cauterization. His social history was remarkable for occasional drinking, marijuana use, and recent use of synthetic marijuana.His vital signs were a heart rate of 85 bpm, blood pressure of 135/80 mmHg, temperature of 98°F, and pulse oximetry of 100% on room air. Blood work revealed a hemoglobin of 13, hematocrit of 39, platelet of 250, PT of 35, INR of 8, and a PTT of 140.Reports have recently been recounted of synthetic cannabinoids adulterated with brodifacoum, a long-acting vitamin K antagonist normally used in rat poison. More than 160 people presented to a U.S. health care facility between March and April 2018 with unexplained bleeding. Four fatalities were reported, all in Illinois. Lab testing confirmed the presence of brodifacoum in 18 people. Users described bleeding from their eyes and ears as well as heavy menstrual periods, frequent and severe nose bleeds, and gum bleeding.​This outbreak appears to be from an unintentional adulteration of synthetic marijuana, but some reports have users intentionally smoking...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs