RESUMEN
Se presenta un caso de intoxicaci�n mortal por ingesti�n del raticida Brodifacum, un anticoagulante superwarfar�nico, junto con otros f�rmacos, entre los que se inclu�an antiinflamatorios no esteroideos y un disolvente org�nico de uso dom�stico. El sujeto falleci� en la UCI, con un cuadro de insuficiencia respiratoria aguda, seguida de fallo hep�tico y renal. En la autopsia se pusieron de manifiesto lesiones hemorr�gicas circunferenciales que afectaban a diversos tejidos, entre los que se encontraban la grasa mesent�rica, el epicardio, y la grasa perirrenal. El estudio microsc�pico demostr� la existencia de una t�pica lesi�n hemorr�gica aguda, circunferencial, en los nervios vegetativos epic�rdicos y del �rea del espl�cnico. La explicaci�n de porqu� los nervios perif�ricos vegetativos se constituyen en diana de los efectos t�xicos se atribuye a la acci�n combinada de los disolventes y de los anticoagulantes, sobre el sistema nervioso perif�rico. Se sabe que los disolventes org�nicos producen una lesi�n neuronal aguda, consistente en tumefacci�n axonal y del soma neuronal, que conlleva a la alteraci�n del sistema de transporte a lo largo del ax�n. Creemos que -desde el punto de vista fisiopatol�gico- la vasodilataci�n reactiva de los vasa nervorum, producida a consecuencia de la lesi�n neuronal aguda inducida por los disolventes, unida al estado de hipocoagulabilidad sangu�nea -dependiente de la ingesti�n de Brodifacum (superwarfarina) y potenciada por los antiinflamatorios no esteroideos- constituyen los mecanismos �ntimos que podr�an explicar esta peculiar Neuropat�a Hemorr�gica Aguda T�xica de los nervios perif�ricos del Sistema Nervioso Neurovegetativo. Desconocemos si los nervios perif�ricos mixtos se encontraban afectados por esta lesi�n, al carecer de muestras para un estudio definitivo.
Palabras clave: Brodifacum. Warfarina. Disolventes. AINES. Antihistam�nicos. Intoxicaci�n fatal. Neuropat�a hemorr�gica t�xica. Raticidas. Toxicolog�a forense. Patolog�a.
ABSTRACT
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.
Key words: Brodifacoum. Warfarin. Solvents. NSAIDS. Antihistaminics. Fatal poisoning. Acute toxic haemorrhagic neuropathy. Rodenticides. Forensic toxicology. Pathology.
