Clinical Approach

A number of agents with distinct toxicities are used as rodenticides. The clinical approach to rodenticide exposure is determined by whether the nature of the toxin is known or unknown or whether delayed toxicity is suspected. Identifying product name is essential for appropriate management, but actual active ingredients need to be known over the commercial name. It must be recognized that similar brand names are used for more than one agent and that some agents are no longer on the market but remain on consumers' shelves. The time of ingestion and onset of clinical symptoms should be elicited. If a specific agent is identified, evaluation and treatment are determined. It must be recognized that chemicals can be mistakenly termed rodenticides when obtaining a history and that ingestion may involve coingestants.

If a clinician only knows that a rodenticide was ingested, specific odors or CNS, cardiopulmonary, gastrointestinal, skeletal muscle, metabolic, or hemorrhagic signs and symptoms may suggest a specific toxin. A metabolic acidosis suggests sodium monofluoroacetate or its derivatives. Painful paresthesias and metallic densities on abdominal radiographs suggest thallium ingestion. Emesis and cardiac dysrythmias suggest red squill poisoning. An abnormally high PT suggests superwarfarin ingestions, but the Pt may be normal initially.

Initial assessment includes immediate identification and resuscitation of any airway compromise, respiratory failure, or cardiovascular collapse. Vital signs including an accurate core temperature should be obtained immediately. Administration of diagnostic/therapeutic substrates should be considered. Orogastric lavage may be indicated if ingestion took place within 1 h, followed by activated charcoal and a cathartic. Specific antidotes are considered. Blood chemistries other than an initial PT are not particularly helpful unless the patient is clinically symptomatic.

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