{"id":10374,"date":"2025-03-01T14:07:49","date_gmt":"2025-03-01T19:07:49","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan397\/"},"modified":"2025-03-02T00:54:32","modified_gmt":"2025-03-02T05:54:32","slug":"dhan397","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan397\/","title":{"rendered":"php\/alerts\/dhan397 ~  Division of Public Health &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan397.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->397 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->December 18, 2018 3:10 pm <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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2) the emergence of 2 new clinical scenarios; and 3) recommendations to help clinicians make decisions related \n\n\n\n\n\nto these 2 new clinical scenarios.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>This is an update to the Health Alert Network (HAN) advisory released on May 25, 2018 titled Outbreak of Life-threatening \n\n\n\n\n\nCoagulopathy Associated with Synthetic Cannabinoids Use <a href=\"https:\/\/emergency.cdc.gov\/han\/han00410.asp\">(https:\/\/emergency.cdc.gov\/han\/han00410.asp)<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Outbreak Update<\/h2>\n\n\n\n\n\n<p>Since the index patient with hypocoagulopathy associated with synthetic cannabinoids use was identified on March 8, 2018 \n\n\n\n\n\nin Illinois, at least 324 people have presented to healthcare facilities with serious bleeding from possible exposure. The \n\n\n\n\n\nlargest number of patients were in Illinois (164), followed by Wisconsin (86), Maryland (44), Florida (6), Pennsylvania (6), \n\n\n\n\n\nMissouri (5), North Carolina (5), Indiana (5), Kentucky (1), Virginia (1), and West Virginia (1). Laboratory investigation \n\n\n\n\n\nconfirmed brodifacoum exposure in at least 150 patients. There have been at least eight (8) fatalities. Vitamin K1 continues \n\n\n\n\n\nto be the recommended therapy. Since the original HAN advisory on May 25, 2018, two (2) new clinical scenarios have emerged:<\/p>\n\n\n\n\n\n<ol> \n\n\n\n\n\n<li>Several patients have outpatient follow-up blood brodifacoum concentrations that are higher than their initial blood brodifacoum \n\n\n\n\n\nconcentrations.<\/li>\n\n\n\n\n\n<li>At least one patient has become pregnant since starting outpatient oral Vitamin K1 treatment.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<p>When patients are found to have outpatient follow-up blood brodifacoum concentrations higher than their initial blood brodifacoum \n\n\n\n\n\nconcentrations, it strongly suggests that they have continued or resumed using synthetic cannabinoid products containing brodifacoum \n\n\n\n\n\nwhile on oral vitamin K1 therapy. The consequences of re-exposure to brodifacoum include:<\/p>\n\n\n\n\n\n<ol> \n\n\n\n\n\n<li>Risk of life-threatening hemorrhage,<\/li>\n\n\n\n\n\n<li>Oral vitamin K1 dosing may need to be increased, and<\/li>\n\n\n\n\n\n<li>Oral vitamin K1 treatment duration may need to be extended.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<p>Pregnancies in patients who are on oral vitamin K1 treatment for brodifacoum toxicity are high-risk pregnancies. Brodifacoum crosses \n\n\n\n\n\nthe placenta. Both mother and fetus are at risk for serious bleeding. Brodifacoum may also be a teratogen because its chemical structure \n\n\n\n\n\nis similar to warfarin, a known teratogen.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations for Clinicians<\/h2>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>Maintain a high index of suspicion for continued or resumed use of synthetic cannabinoid products containing brodifacoum in patients \n\n\n\n\n\nwho are on oral vitamin K1 therapy. Ask these patients about continued or resumed use of synthetic cannabinoid products.<\/li> \n\n\n\n\n\n<li>Counsel against resuming or continuing use of synthetic cannabinoid products. Refer patients to the Substance Abuse and Mental Health \n\n\n\n\n\nServices Administration (SAMHSA) national helpline, 1-800-662-HELP(4357), a free, confidential, 24\/7, 365-day-a-year treatment referral \n\n\n\n\n\nand information service in English and Spanish for individuals and families facing mental and\/or substance use disorders;  substance abuse \n\n\n\n\n\ncounseling is also available.<\/li>\n\n\n\n\n\n<li>Advise patients that their current oral vitamin K1 dosing may not prevent recurrent coagulopathy from re-exposure to brodifacoum in \n\n\n\n\n\nsynthetic cannabinoid products and the duration of oral vitamin K1 treatment may need to be extended.<\/li>\n\n\n\n\n\n<li>Consider periodic quantitative testing of patients\ufffd blood for brodifacoum during outpatient follow-up visits to inform if patients \n\n\n\n\n\ncontinued or resumed use of synthetic cannabinoid products containing brodifacoum. In addition, serial blood brodifacoum concentrations \n\n\n\n\n\nallow for calculation of blood brodifacoum half-life and assist in determining duration of oral vitamin K1 therapy.<\/li>\n\n\n\n\n\n<li>Ask all women of childbearing age who are on oral vitamin K1 therapy about the possibility of being pregnant and counsel them about \n\n\n\n\n\nreliable contraceptive techniques. A periodic pregnancy test should be performed on all women of childbearing age who are on oral vitamin \n\n\n\n\n\nK1 therapy. Pregnant patients on oral vitamin K1 should be referred for high-risk pregnancy management and follow-up.<\/li>\n\n\n\n\n\n<li>Contact your local poison control center (1-800-222-1222) for questions on diagnostic testing and management of these patients.<\/li>\n\n\n\n\n\n<li>Promptly report possible cases to your local or state health department.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations for the Public<\/h2>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>CDC recommends that people do not use synthetic cannabinoid products. Synthetic cannabinoid products are always dangerous because it \n\n\n\n\n\nis impossible for people to know what chemicals are in the product, how much they are being exposed to, and how their body will react to \n\n\n\n\n\nthe chemicals. The synthetic cannabinoid products associated with this outbreak are especially dangerous because they contain brodifacoum, \n\n\n\n\n\na chemical used as rat poison that can cause uncontrolled bleeding.<\/li>\n\n\n\n\n\n<li>People who have used synthetic cannabinoid products in the past three months and are concerned about their health should contact their \n\n\n\n\n\nhealthcare provider. Synthetic cannabinoid products users who develop any unusual bruising or bleeding should immediately seek medical attention.<\/li>\n\n\n\n\n\n<li>People who are currently on oral vitamin K1 treatment for brodifacoum poisoning should not use synthetic cannabinoid products, as this \n\n\n\n\n\ncan cause new or worsening bleeding and may prolong the course of vitamin K1 treatment. Substance Abuse and Mental Health Services Administration \n\n\n\n\n\n(SAMHSA) national helpline, 1-800-662-HELP(4357), is a free, confidential, 24\/7, 365-day-a-year treatment referral and information service \n\n\n\n\n\nin English and Spanish for individuals and families facing mental and\/or substance use disorders.<\/li>\n\n\n\n\n\n<li>Women who are currently on oral vitamin K1 treatment for brodifacoum poisoning should use an effective contraceptive method to prevent \n\n\n\n\n\npregnancy while being treated.<\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n<h2>For More Information<\/h2>\n\n\n\n\n\n<ol>\n\n\n\n\n\n<li>CDC Clinician Outreach and Communication Activity: Outbreak Alert Update: Potential Life-Threatening Vitamin K-Dependent Antagonist \n\n\n\n\n\nCoagulopathy Associated With Synthetic Cannabinoids Use.\n\n\n\n\n\n<a href=\"https:\/\/content.govdelivery.com\/accounts\/USCDC\/bulletins\/21e1a0f\">https:\/\/content.govdelivery.com\/accounts\/USCDC\/bulletins\/21e1a0f<\/a><\/li>\n\n\n\n\n\n<li>Synthetic cannabinoids: What are they? What are their effects? \n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/nceh\/hsb\/chemicals\/sc\/default.html\">https:\/\/www.cdc.gov\/nceh\/hsb\/chemicals\/sc\/default.html<\/a><\/li>\n\n\n\n\n\n<li>Synthetic cannabinoids: An Overview for Healthcare Providers.\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/nceh\/hsb\/chemicals\/sc\/healthcare.html\">https:\/\/www.cdc.gov\/nceh\/hsb\/chemicals\/sc\/healthcare.html<\/a><\/li>\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n<br>\n\n\n\n\n\n<p>The Centers for Disease Control and Prevention (CDC) protects people&#8217;s health and safety by preventing and controlling diseases and injuries; \n\n\n\n\n\nenhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships \n\n\n\n\n\nwith local, national, and international organizations.<\/p>\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p><!--[END]-->\n\n\n  \n\n\n        <div class=\"panel panel-danger\">\n\n\n          <div class=\"panel-heading\">    \n\n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n\n       <\/div>\n\n\n       <div class=\"panel-body\">\n\n\n      <ul>\n\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n\n            <\/ul>\n\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n\n          <\/div> \n\n\n        <\/div><br>  \n\n\n\n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #397 December 18, 2018 3:10 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10374","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10374","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10374"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10374\/revisions"}],"predecessor-version":[{"id":11550,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10374\/revisions\/11550"}],"up":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10374"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}