What is the appropriate emergency management for a patient who has ingested rat poison?

Emergency Management of Rat Poison Ingestion

Immediately activate emergency medical services (EMS) and contact the Poison Control Center (1-800-222-1222 in the United States) for specific guidance, as rat poison ingestion requires expert toxicological consultation that varies based on the specific rodenticide type. 1, 2

Immediate Actions

Do Not Delay Emergency Response

• Activate EMS immediately if the patient exhibits any signs of life-threatening conditions including sleepiness, seizures, difficulty breathing, or vomiting 1
• Contact the Poison Control Center (1-800-222-1222) while initiating emergency response, as specific rat poison formulations require different management strategies 1, 2
• Do not delay EMS activation while attempting any home interventions 2

Critical "Do Not" Recommendations

Do not administer anything by mouth (including water, milk, or any other substance) unless specifically directed by poison control or emergency medical personnel, as this may cause harmful emesis and aspiration 1, 2

• Do not induce vomiting or administer ipecac syrup - this is contraindicated and provides no clinical benefit while potentially causing aspiration of toxic substances 1, 2
• Do not attempt dilution with water or milk, as no human studies demonstrate clinical benefit and administration may cause emesis and aspiration 1, 2
• Do not administer activated charcoal at home unless specifically advised by poison control 1, 2

Rat Poison-Specific Considerations

Zinc Phosphide (Common Rodenticide)

• Do not induce vomiting, as this can cause aspiration of phosphine gas, a highly toxic byproduct 2
• Do not perform gastric lavage unless specifically directed by poison control 2
• Activated charcoal (1 g/kg) via small-bore nasogastric tube may be administered only if specifically recommended by poison control, though evidence for efficacy is limited 2

Anticoagulant Rodenticides (e.g., Brodifacoum)

• FDA labeling mandates immediate medical help or poison control contact if swallowed 3
• These require specialized management for potential coagulopathy, which develops over hours to days

Information to Gather for Poison Control

When contacting poison control or EMS, provide the following critical information: 1

• Nature and time of exposure - when the ingestion occurred
• Name of the product - bring the container if available, as rat poisons contain different active ingredients (anticoagulants, zinc phosphide, bromethalin, cholecalciferol)
• Amount ingested - estimated dose if known
• Patient's age and symptoms - current clinical status

Common Pitfalls to Avoid

• Do not assume all rat poisons are the same - different rodenticides (anticoagulants vs. zinc phosphide vs. bromethalin) require completely different management approaches 2
• Do not waste time with home decontamination attempts - the priority is rapid transport to emergency care where specific antidotes (such as vitamin K for anticoagulant rodenticides) can be administered 1, 2
• Do not rely on the absence of immediate symptoms - many rat poisons have delayed toxicity, particularly anticoagulant rodenticides which may not cause bleeding for 24-72 hours 1

Hospital-Level Management

Once EMS arrives or at the emergency department: 1

• Standard life support measures take priority (airway, breathing, circulation)
• Activated charcoal may be considered by healthcare professionals if the patient is fully conscious, can swallow safely, and presents within 1-2 hours of ingestion 1
• Specific antidotes will be determined based on the rodenticide type identified