From the Guidelines
If you suspect rat poison ingestion, seek immediate medical attention or call poison control, as prompt treatment is crucial to prevent fatal hemorrhage. The treatment for rodenticide poisoning typically involves vitamin K1 administration, which counteracts the blood-thinning effects of the poison 1.
Key Considerations
- For adults, typical dosing is 10-25mg orally every 6-8 hours, while children receive 0.6-0.7mg/kg/day divided into multiple doses.
- Treatment duration ranges from 2-4 weeks depending on the specific poison involved.
- Blood tests to measure clotting function (PT/INR) will guide treatment.
- In severe cases with active bleeding, hospital admission for fresh frozen plasma, prothrombin complex concentrate, or blood transfusions may be necessary.
Additional Measures
- Activated charcoal may be administered if the ingestion was recent (within 1-2 hours) 1.
- Rat poisons work by blocking vitamin K recycling in the liver, preventing the formation of clotting factors and potentially causing fatal hemorrhage.
- The delayed onset of symptoms (24-72 hours after ingestion) makes prompt treatment crucial even if the person initially appears well.
General Approach
- Treatment and stabilization of critically poisoned patients often must be performed before the poison involved is known 1.
- Timely and effective supportive care, including airway management, hemodynamic support, and correction of critical vital sign and metabolic derangements, is essential to the care of the poisoned patient.
From the Research
Treatment Overview
The treatment for rodenticide poisoning typically involves the administration of vitamin K1 to address coagulopathy and bleeding symptoms.
- The dosage of vitamin K1 required during the maintenance period is influenced by the vitamin K1 sustained treatment time (VKSTT) 2.
- Treatment of acute hemorrhagic symptoms often requires intravenous vitamin K1 in excess of 50 to 100 mg, while chronic maintenance may involve 100 mg PO vitamin K1 daily 3.
Administration of Vitamin K1
Vitamin K1 is administered to counteract the anticoagulant effects of rodenticides.
- The treatment may involve an initial pulse therapy, followed by maintenance therapy with vitamin K1 2.
- The maintenance dose of vitamin K1 can be gradually decreased over time, and is not related to toxicant concentration 2.
Adjunctive Therapies
In some cases, adjunctive therapies may be necessary to manage bleeding and coagulopathy.
- Fresh frozen plasma may be administered as a precautionary measure to address coagulopathy 4, 5.
- Recombinant factor VIIa and prothrombin complex concentrate have been used as adjunctive hemostatic therapy 3.
- Phenobarbital may be used to expedite LAAR metabolism 3.
Monitoring and Follow-up
Frequent monitoring of coagulation function, particularly prothrombin time (PT), is essential to prevent hemorrhagic complications and adjust vitamin K1 therapy as needed.