NAC Dosing in Rodenticide Poisoning
NAC is not indicated for rodenticide poisoning. The evidence provided exclusively addresses NAC use for acetaminophen (paracetamol) overdose, not rodenticide toxicity 1, 2.
Critical Distinction
Rodenticides are a diverse class of poisons including anticoagulants (warfarin, brodifacoum), bromethalin, cholecalciferol, zinc phosphide, and others—none of which are treated with NAC 1.
NAC is the specific antidote for acetaminophen toxicity only, working by replenishing glutathione stores and preventing formation of the toxic metabolite NAPQI 1, 2.
Why This Matters
Administering NAC for rodenticide poisoning would be ineffective and potentially delay appropriate treatment. Each rodenticide class requires specific management:
- Anticoagulant rodenticides require vitamin K1 therapy, not NAC 1.
- Bromethalin requires decontamination and supportive care with no specific antidote 1.
- Cholecalciferol requires management of hypercalcemia 1.
If Acetaminophen Co-Ingestion is Suspected
Only if there is documented or suspected acetaminophen co-ingestion with rodenticide should NAC be considered, using standard acetaminophen overdose protocols 1, 2:
- Oral NAC: 140 mg/kg loading dose, then 70 mg/kg every 4 hours for 17 doses 1, 2.
- IV NAC: 150 mg/kg over 15 minutes, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours 1, 2.
Appropriate Management for Rodenticide Poisoning
Contact your regional poison control center immediately for specific guidance on the particular rodenticide involved, as management varies dramatically by agent type 1.