Disposition depends on the toxin ingested. When exposure is suspected, given the low frequency of individual physician experience with these types of exposures, poison center consultation may assist in recommending a plan for managing the patient based on the presentation and toxin. When a patient has been exposed to a rodenticide having a rapid effect, symptoms usually manifest within 4 to 6 h of ingestion. Patients who have ingested a highly toxic rodenticide and are symptomatic are admitted after initial ED therapy. Symptoms related to agents with delayed onset typically begin 12 h or more after exposure. Therefore, if there is historical evidence of an acute ingestion and there are no signs or symptoms within 4 to 6 h, rodenticides with delayed effects are then considered, the patient is discharged after initial therapy, and reevaluation with coagulation studies is done in 24 and 48 h. The threshold for hospital admission should be low for intentional ingestions. In accidental ingestions, the patient can be treated with decontamination, observed in the ED for 6 h, and, if asymptomatic, discharged with follow-up. For asymptomatic patients who have accidentally ingested a superwarfarin, baseline PT and PTT determinations are done, follow-up is ensured, and coagulation studies are repeated at 24 and 48 h. Prevention measures should be emphasized.
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