PEORIA — Thirty-four of the Peoria area Spice users poisoned by rat killer earlier this year are the subject of a study published in the New England Journal of Medicine this week.
“Our hope is that health care providers who read this will be better prepared to identify symptoms of superwarfarin poisoning and be able to appropriately manage it,” said Dr. Michael Tarantino, a professor of medicine and pediatrics at the University of Illinois College of Medicine Peoria, the director of the Bleeding and Clotting Disorders Institute and a co-author of the series case study.
The article detailed the outbreak and the therapy provided in 34 patients admitted to OSF HealthCare Saint Francis Medical Center between March and April. In patients who were tested, results were positive for brodifacoum, or superwarfarin, a lethal class of toxins commonly used to kill rats. Symptoms were controlled with vitamin K replacement therapy. One patient in the report died from complications of spontaneous brain hemorrhage.
For medical professional, having research published in a national medical journal is a big deal, but being published in the New England Journal of Medicine is a really big deal, said Tarantino.
“This is the first time in Peoria history where a study that was conducted and analyzed and reported has made it into the New England Journal of Medicine,” he said. “Our colleagues have been mentioned in the Journal as part of large study groups, but this is the first time Peoria authors have been in the New England Journal of Medicine.”
Three of the study’s five authors were doctors still in training, said Tarantino. Dr. Amar H. Kelkar, who at the time was a resident in internal medicine, took the lead in documenting the outbreak and writing up the study, said Tarantino.
“I think at one point Dr. (Jonathan) Roberts or I said to him ‘you should write this case up,’ and he took it upon himself to do that,” said Tarantino.
Kelkar is now a Fellow at the University of Florida studying hematology/oncology.
When patients began coming into area emergency rooms with uncontrolled bleeding in March doctors quickly determined that the situation was related to batch of synthetic cannabis tainted with rat poison. Over the course of the outbreak four people died and more than 150 people were sickened across Illinois. Synthetic cannabinoids, commonly referred to or sold under names like “Spice” or “K2,” are lab-created drugs created designed to induce calm while stimulating euphoria.
Of the 34 patients in the Peoria study, 75 percent had multiple bleeding symptoms and more than half had blood in their urine. Included in the study are details of the symptoms and treatment given to a 37-year-old woman who died of brain hemorrhage. The study also mentioned six people who were readmitted after either leaving the hospital against medical advice, or being unable to fill their prescriptions of vitamin K and subsequently relapsing.
“Some alarming behaviors were noted among this subgroup, including recurrent use of the same batch of synthetic cannabinoids in two patients. One patient had attempted to donate plasma and was readmitted to the hospital because of prolonged bleeding from the injection site,” the study said.
The study offers detailed information not only into the drama as it unfolded, but how doctors treated symptoms.
“It really exemplified how a multi-disciplinary team of doctors put their heads together to figure out what was this was, and to use our knowledge to come up with treatment options,” Tarantino said. “We can replenish their vitamin K, but when they are bleeding in front of you, we had to do other things to stop the bleeding in those patients. I think an important take-home message to this article is that you need a community of experts to handle what turned out to be an epidemic of something really terrible.”
While it’s a great honor to get published in the New England Journal of Medicine, the ultimate goal is to pass on knowledge, said Tarantino.
“The New England Journal of Medicine is read more than any other medical journal, and hopefully the physicians who read it will have something in their memory that, when the next patient comes in (with symptoms of superwarfarin poisoning), the physician will recall having read it. With today’s technology they could easily access the article and know what was done in Peoria, and potentially have more expedient treatment for that patient.”
Leslie Renken can be reached at 686-3250 or firstname.lastname@example.org. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.