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Surreptitious Coumadin Ingestion

Final Diagnosis

Discharge Condition

Patient's condition on discharge improved.

Discharge Medication:
1. Humulin®
2. Darvocet N-100®

Discharge Disposition: Patient will return to outpatient clinic in one week.

On the day prior to discharge, the patient's PT and PTT were normal and the patient's warfarin level returned positive and, in fact, was in the therapeutic range. A return to the patient's bedside and further discussions with the patient about the latest laboratory data found that the patient did admit that, for example, if she felt swollen, her friends would get her Lasix® to take.

When that did not help her friends would give her blood thinners so she would feel better. She was informed that either accidentally or deliberately, she was getting coumadin and the significance of this was made clear to her. She was instructed to dispose of all medications at home and take only the new medications which were prescribed for her. A follow up with the pharmacist where the patient was employed indicated that the patient's friends were pharmacy technicians employed only a short time. The pharmacist would take appropriate action.

The patient's elevated IgE level and eosinophilia were felt to be due to an insulin allergy.