What is the treatment for rodenticide (rat kill) poisoning?

Treatment for Rodenticide (Rat Kill) Poisoning

The immediate treatment for rodenticide poisoning requires contacting a poison control center (1-800-222-1222 in the US) and providing supportive care while administering specific antidotes based on the type of rodenticide involved. 1

Initial Management

• Contact your regional poison control center immediately for expert guidance on management of the specific poisoning case 1
• Do not administer anything by mouth (including water or milk) unless advised by poison control center or emergency medical personnel 1
• Do not administer syrup of ipecac as it has no clinical advantage and may cause intractable vomiting and delayed care 1
• Do not administer activated charcoal unless specifically advised by poison control center 1

Assessment and Identification

• Identify the toxidrome (combination of signs and symptoms) to provisionally identify the likely class of poison 1
• Determine if the rodenticide is:
  • Anticoagulant type (warfarin or "superwarfarin" such as brodifacoum, bromadiolone)
  • Non-anticoagulant type (bromethalin, strychnine, zinc phosphide)
• Look for specific symptoms:
  • Anticoagulant poisoning: epistaxis, gingival bleeding, bruising, hematomas, hematuria, gastrointestinal bleeding 2, 3
  • Bromethalin poisoning: neurological symptoms including seizures 4

Treatment for Anticoagulant Rodenticide Poisoning

Anticoagulant rodenticides (most common type) require:

• For active bleeding:

  • Administer prothrombin complex concentrate (50 units/kg) or fresh frozen plasma (15 mL/kg) 3
  • Give vitamin K1 (phytomenadione) 10mg intravenously for adults (100 μg/kg for children) 2, 3

• For elevated INR without active bleeding:

  • If INR ≥4.0: administer vitamin K1 10mg intravenously 3
  • If INR <4.0: no treatment required but monitor 3

• For long-term management:

  • High-dose oral vitamin K1 (typically 100mg daily) may be needed for extended periods (average 168 days for long-acting anticoagulants) 2
  • Regular monitoring of coagulation parameters is essential 2, 3

Special Considerations

• Pediatric exposures to anticoagulant rodenticides:

  • Most pediatric exposures involve small amounts and rarely cause significant toxicity 2, 5
  • Routine INR measurement is unnecessary for asymptomatic children with small, unintentional exposures 3

• Pregnancy:

  • Aggressive vitamin K therapy is required to control maternal coagulopathy 6
  • Monitor fetus for potential hemorrhage via ultrasound 6

• Intentional ingestions:

  • These cases typically involve larger amounts and require more aggressive treatment and monitoring 4, 5
  • May require higher doses of vitamin K and longer treatment courses 2

Monitoring and Follow-up

• For anticoagulant poisoning:

  • Monitor INR at 36-48 hours post-exposure 3
  • If normal at this time, no further action required 3
  • For significant exposures, continued monitoring may be necessary for weeks or months 2, 3

• For non-anticoagulant poisoning:

  • Treatment is primarily supportive and symptom-based 4
  • No specific antidotes are available for bromethalin poisoning 4

Common Pitfalls to Avoid

• Do not delay contacting poison control while attempting home remedies 1
• Do not assume all rodenticides are anticoagulants; identification of the specific agent is crucial 4
• Do not discontinue vitamin K therapy prematurely in cases of long-acting anticoagulant poisoning, as rebound coagulopathy can occur 2, 3
• Do not underestimate the potential for prolonged toxicity with superwarfarins, which can cause anticoagulation for weeks to months 2, 3