From the Guidelines
The initial workup for rat poison ingestion should prioritize identifying the type of poison and assessing the patient's clinical status, with immediate initiation of supportive care and antidotal therapy as needed, based on the most recent guidelines from 2023 1. The management of rat poison ingestion is crucial for preventing morbidity, mortality, and improving quality of life. Key steps include:
- Determining the specific rodenticide involved, as treatments differ significantly between anticoagulant (warfarin-based) and non-anticoagulant types.
- For anticoagulant rodenticide ingestion, obtaining baseline coagulation studies including PT/INR, PTT, and CBC, and monitoring these values for 48-72 hours as coagulopathy may develop gradually.
- Administering vitamin K1 (phytonadione) as the antidote for anticoagulant poisoning, typically at 10-25mg orally every 6 hours for adults, with duration based on the specific agent.
- Providing supportive care for non-anticoagulant rodenticides, as specific antidotes are limited, and considering gastric decontamination with activated charcoal (1g/kg) if presentation occurs within 1-2 hours of ingestion.
- Assessing vital signs, mental status, and signs of bleeding or specific toxicity, and performing laboratory evaluations, including comprehensive metabolic panels, to guide targeted supportive care.
The approach to managing rat poison ingestion is supported by the latest guidelines, which emphasize the importance of timely and effective supportive care, including airway management, hemodynamic support, and correction of critical vital sign and metabolic derangements 1. Additionally, consultation with a medical toxicologist or certified regional poison center is recommended for urgent cases, as they can provide valuable guidance on the management of critically poisoned patients 1.
From the Research
Rat Poison Ingestion Workup
- The workup for rat poison ingestion typically involves laboratory evaluation to confirm the diagnosis, as the symptoms can be non-specific and similar to those of vitamin K deficiency 2.
- Coagulation profile, including prothrombin time, international normalized ratio, and activated partial thromboplastin time, can be abnormal in patients with rat poison ingestion 3.
- Plasma bromadiolone levels can be measured to confirm the diagnosis, and serial measurements can demonstrate the elimination kinetics of the toxin 3.
- In some cases, the diagnosis may be challenging due to the varying sensitivities of available assays, and repeat testing may be warranted 2.
Treatment Implications
- Treatment of rat poison ingestion typically involves administration of vitamin K to reverse the coagulopathy 2.
- Prothrombin complex concentrates can be used in combination with vitamin K for urgent reversal of vitamin K antagonist-associated major bleeding 4, 5, 6.
- Prothrombin complex concentrates have been shown to be superior to fresh frozen plasma for emergency reversal of vitamin K antagonists, with better reversal of INR and lower risk of treatment-related adverse events 6.
Diagnostic Considerations
- A high index of suspicion is necessary to diagnose rat poison ingestion, as the symptoms can be non-specific and similar to those of other conditions 2.
- Laboratory evaluation should include coagulation profile and plasma bromadiolone levels to confirm the diagnosis 3, 2.
- Repeat testing may be necessary if the initial results are negative, but the clinical suspicion remains high 2.