What is the treatment for rodenticide poisoning?

Treatment for Rodenticide Poisoning

For rodenticide poisoning (ratol), treatment depends on the specific type of rodenticide, with long-acting anticoagulant rodenticides requiring vitamin K therapy and yellow phosphorus poisoning requiring aggressive supportive care and possible liver transplantation in severe cases.

Types of Rodenticides and Their Management

1. Long-Acting Anticoagulant Rodenticides (LAAR)

These are the most common rodenticides (e.g., warfarin, brodifacoum) that work by inhibiting vitamin K-dependent clotting factors.

Initial Assessment:

• Determine intent: Self-harm cases require immediate ED referral regardless of dose 1
• Check for symptoms of bleeding or bruising which require immediate ED referral 1
• Assess for chronic ingestion which requires immediate evaluation 1

Management Algorithm:

• For asymptomatic patients with unintentional ingestion:

  • Less than 1 mg of active ingredient: Can be safely observed at home without laboratory monitoring 1
  • 1 mg or more of active ingredient: Evaluate for coagulopathy at 48-72 hours after exposure 1

• For symptomatic patients or intentional ingestion:

  • Immediate ED referral
  • Baseline prothrombin time measurement
  • Vitamin K1 (phytonadione) administration for documented coagulopathy
  • Fresh frozen plasma for active bleeding

• For patients already on anticoagulants:

  • Baseline PT measurement and repeat at 48-72 hours 1

2. Yellow Phosphorus Rodenticides (Ratol)

Yellow phosphorus is a highly toxic protoplasmic poison that can cause multiorgan failure, particularly affecting the liver.

Management:

• Immediate ED referral for any suspected ingestion

• Aggressive supportive care:

  • IV fluid resuscitation
  • Correction of electrolyte abnormalities
  • Monitoring of liver, renal, and cardiac function
  • Monitor pancreatic enzymes (amylase, lipase) as acute pancreatitis can occur 2

• For fulminant hepatic failure:

  • Consider liver transplantation if King's College criteria are met 2
  • Monitor for post-transplant complications including acute pancreatitis 2

3. Cyanide-Containing Rodenticides

Management:

• Immediate administration of hydroxocobalamin (first-line antidote) 3
• If hydroxocobalamin is unavailable, administer sodium nitrite 3
• Consider adding sodium thiosulfate to enhance cyanide elimination 3
• Administer 100% oxygen 3

General Management Principles for All Rodenticide Poisonings

Gastrointestinal Decontamination:

• Activated charcoal: Consider only if patient presents within 1-2 hours of ingestion and is fully conscious 4
• Do not induce emesis with ipecac syrup under any circumstances 4, 1
• Gastric lavage is only justified in rare life-threatening cases when the rodenticide is not adsorbed by activated charcoal 4

Supportive Care:

• Airway management and respiratory support if needed 5
• Cardiovascular support with fluids and vasopressors for hypotension 5
• Seizure control with benzodiazepines if needed 5
• Continuous cardiac monitoring 5
• Serial assessment of vital signs, mental status, and organ function 5

Special Considerations

For Yellow Phosphorus (Ratol) Poisoning:

• Monitor for delayed hepatotoxicity even if initially asymptomatic
• Watch for signs of acute pancreatitis which may complicate management 2
• Consider early transfer to a liver transplant center if signs of severe hepatic injury develop

For Pregnant Patients:

• Pregnant patients with unintentional exposure to less than 1 mg of LAAR active ingredient should be evaluated by their obstetrician or primary care provider 1

Common Pitfalls to Avoid

1. Delaying treatment while waiting for laboratory confirmation
2. Failing to contact poison control center for guidance (1-800-222-1222 in the US) 5
3. Administering vitamin K prophylactically without evidence of coagulopathy 1
4. Discharging patients too early after yellow phosphorus ingestion (hepatotoxicity may be delayed)
5. Missing concomitant exposures in mixed ingestions

Always contact your regional poison center for expert guidance on specific cases, as management may need to be tailored based on the specific rodenticide involved and patient factors.