Abstract

GARFIA, A. et al. Acute toxic haemorrhagic neuropathy and multiorganic failure following poisoning by anticoagulants, solvents, nsaids and antihistaminic drugs: Report of a fatal case. Cuad. med. forense [online]. 2002, n.27, pp.61-70. ISSN 1988-611X.

In this paper we describe a case of mortal poisoning by ingestion of the rodenticide Brodifacoum, a superwarfarin anticoagulant, together with other drugs, among which were non steroid anti-inflammatory drugs and a domestic organic solvent. The individual died in the Intensive Care Unit, with acute respiratory insufficiency, followed by hepatic and renal failure. At autopsy round haemorrhagic lesions were seen, which affected several tissues, among which were mesenteric fat, the epicardium, and the peri-renal fat. Microscopic study revealed the existence of a typical acute haemorrhagic lesion, located around the epicardial vegetative nerves and those found in the splanchnic beds. The reason why the peripheral vegetative nerves constitute the target of the toxic effects is attributed to the combined action of the solvents together with the superwarfarin drug, on the Peripheral Nervous System. It is known that organic solvents produce an acute neuronal lesion, consisting in tumefaction of the axon and the neuronal soma, which leads to the alteration of the system of transport (neurotubules) along the axon. We believe that - from a physiological point of view - the reactive vascular congestion of the vasa-nervorum, produced as a consequence of the acute neuronal lesion induced by the solvents, together with the state of hipocoagulability of the blood - due to the ingestion of the superwarfarin (Brodifacoum) and potentiated by the the anticoagulant action of the non steroid anti-inflammatory drugs - make up the intimate mechanisms which could explain this characteristic Acute Toxic Haemorrhagic Neuropathy of the peripheral nerves of the Neurovegetative Nervous System. We do not know if the mixed peripheral nerves were affected by this lesion, due to absence of samples for a more definitive study.

Keywords : Brodifacoum; Warfarin; Solvents; NSAIDS; Antihistaminics; Fatal poisoning; Acute toxic haemorrhagic neuropathy; Rodenticides; Forensic toxicology; Pathology.

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