Successful management with hemoperfusion
and antidotal therapy of severe combined
dichlorvos and rodenticide poisoning: a case
report

Successful management with hemoperfusion
and antidotal therapy of severe combined
dichlorvos and rodenticide poisoning: a case
report

Organophosphate poisoning, Rodenticide poisoning, Super warfarin, Hemoperfusion, Hemofiltration

Abstract
Background This case report presents a rare instance of combined dichlorvos (organophosphate) and brodifacoum
(rodenticide) poisoning. By analyzing the clinical presentation and therapeutic course, we aim to provide insights into
the challenges and management strategies associated with multi-agent toxic exposures.
Case presentation A 73-year-old male with a history of hypertension and depression was admitted after ingesting
approximately 150 mL of dichlorvos and 10 mL of brodifacoum. He underwent 18 days of comprehensive treatment,
including gastric decontamination with induced emesis and activated charcoal, administration of specific antidotes
(a total of 1189 mg atropine, 21.8 g pralidoxime iodide, and 660 mg vitamin K1), and extracorporeal detoxification
via hemoperfusion and hemofiltration. Supportive care involved infection control, nutritional supplementation, and
monitoring of coagulation and electrolyte status. The patient developed early complications, including hematemesis,
epistaxis, and persistent coagulopathy, as well as transient alterations in consciousness and cholinesterase levels
below 200 U/L. With prompt and aggressive intervention, his clinical condition gradually stabilized, and he was
discharged in good condition. Follow-up revealed coagulopathy, with deep vein thrombosis requiring oral
anticoagulation.
Conclusion Combined organophosphate and rodenticide poisoning presents a complex toxicological scenario,
characterized by overlapping and synergistic effects on the nervous and coagulation systems. Cholinesterase levels
below 200 U/L may serve as a critical marker of severity in patients without pre-existing liver disease. Hemoperfusion
effectively facilitates toxin clearance, though adjustments to pralidoxime iodide dosing may be warranted during

extracorporeal therapy. Following blood purification therapy, no toxin was detected in the patient’s plasma, and long-
term coagulation abnormalities associated with super warfarin exposure were not observed in this case. Additionally,

Huiying Li1†, Xue Li2†, Biao Du1

, Hongzhi Yu3

, Shasha Fu3
, Yu Guo3
, Hongxia Shao4

, Huaiyong Chen2

, Wanjie Yang5*

and Longyan Ma1*

https://doi.org/10.1186/s12245-025-01004-0

2025

Peri Irawan

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