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Rodenticide Toxicity Clinical Presentation

  • Author: Derrick Lung, MD, MPH; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Dec 29, 2015
 

History

Many of the patients presenting with rodenticide ingestions are children who ingest such substances unintentionally and, thus, usually ingest small quantities. The literature relating to such ingestions is prone to the bias that ingestion may not have actually occurred or that it has occurred at such a low dose as to be inconsequential. Thus, determining the treatment of a child based on published literature is potentially dangerous.

Adults who ingest such substances are most likely attempting suicide; however, poisoning homicides may occur with these agents because of their ready availability. Surreptitious poisoning may occur from exposure to adulterated or contaminated drugs of abuse. The presence of anticoagulation may represent Munchausen syndrome.

Common presenting symptoms after exposure to long-acting anticoagulants include the following:

  • Flank pain with or without frank hematuria
  • Excess bleeding or bruising after relatively minor or no apparent trauma
  • Hemoptysis
  • Epistaxis
  • Menorrhagia

An organophosphate rodenticide known as TresPasitos, made with the chemical aldicarb and sold illegally in the United States, has been used primarily by Hispanic individuals.[10] People who ingest this toxin may present with symptoms of acetyl cholinesterase inhibition.

Additional presentations of rodenticide exposure include the following:

  • Barium - May cause headache, weakness, nausea, abdominal pain, or shortness of breath
  • PNU - May cause complaints of nausea, vomiting, abdominal pain, or dizziness
  • Thallium - Exposed individuals may report acute GI distress and subsequent anorexia, myalgias, painful neuropathy, and hair loss
  • Strychnine - May cause anxiety, muscle twitching, or uncontrolled facial grimacing
  • Zinc phosphide - Inhalation leads to marked shortness of breath as pulmonary edema develops
  • Arsenic - High doses cause nausea, vomiting, bloody diarrhea, and garlic taste in the mouth

Verifying the specific rodenticide is important. In the United States, the rodenticide is most likely an anticoagulant. Quite a few of the other rodenticides have been used over the years but are currently not popular.

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Physical Examination

Anticoagulant rodenticides rarely produce symptoms at all; when they do, however, symptoms are usually delayed. Evidence of frank bleeding, bruising, or other coagulopathy may be present if a significant exposure has occurred. The presence of petechiae under a blood pressure cuff may alert the nursing staff or ED physician to such coagulopathy.

Characteristic odors are associated with certain rodenticides.

  • PNU - Odor of peanuts
  • Zinc phosphide - Smells of rotting fish
  • Organophosphates, such as Tres Pasitos - Smell like garlic
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Contributor Information and Disclosures
Author

Derrick Lung, MD, MPH Assistant Clinical Professor, Department of Emergency Medicine, San Francisco General Hospital; Assistant Medical Director, California Poison Control System, San Francisco Division

Derrick Lung, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Marcus, MD Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, Rutgers New Jersey Medical School, Rutgers University School of Biomedical and Health Sciences; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center

Steven Marcus, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Clinical Toxicology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Acknowledgements

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Director of Medical Toxicology, Allegheny General Hospital

Disclosure: Nothing to disclose.

Assaad J Sayah, MD Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

References
  1. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015 Dec. 53 (10):962-1147. [Medline].

  2. Decker WJ, Baker HE, Tamulinas SH, Korndorffer WE. Two deaths resulting from apparent parenteral injection of strychnine. Vet Hum Toxicol. 1982 Jun. 24(3):161-2. [Medline].

  3. O'Callaghan WG, Joyce N, Counihan HE, Ward M, Lavelle P, O'Brien E. Unusual strychnine poisoning and its treatment: report of eight cases. Br Med J (Clin Res Ed). 1982 Aug 14. 285(6340):478. [Medline]. [Full Text].

  4. Rhyee SH, Heard K. Acute barium toxicity from ingestion of "snake" fireworks. J Med Toxicol. 2009 Dec. 5(4):209-13. [Medline]. [Full Text].

  5. Zolotarevski L, Jovic M, Popov Aleksandrov A, Milosavljevic P, Brajuskovic G, Demenesku J, et al. Skin response to epicutaneous application of anticoagulant rodenticide warfarin is characterized by differential time- and dose-dependent changes in cell activity. Cutan Ocul Toxicol. 2015 Feb 24. 1-8. [Medline].

  6. Spahr JE, Maul JS, Rodgers GM. Superwarfarin poisoning: a report of two cases and review of the literature. Am J Hematol. 2007 Jul. 82(7):656-60. [Medline].

  7. La Rosa FG, Clarke SH, Lefkowitz JB. Brodifacoum intoxication with marijuana smoking. Arch Pathol Lab Med. 1997 Jan. 121(1):67-9. [Medline].

  8. Bochner R. [National Poisoning Information System - SINITOX and human intoxication by pesticides in Brazil]. Cien Saude Colet. 2007 Jan-Mar. 12 (1):73-89. [Medline]. [Full Text].

  9. Dashti-Khavidaki S, Ghaffari S, Nassiri-Toossi M, Amini M, Edalatifard M. Possible unaware intoxication by anticoagulant rodenticide. J Res Pharm Pract. 2014 Oct. 3 (4):142-4. [Medline].

  10. Nelson LS, Perrone J, DeRoos F, Stork C, Hoffman RS. Aldicarb poisoning by an illicit rodenticide imported into the United States: Tres Pasitos. J Toxicol Clin Toxicol. 2001. 39(5):447-52. [Medline].

  11. Bruno GR, Howland MA, McMeeking A, Hoffman RS. Long-acting anticoagulant overdose: brodifacoum kinetics and optimal vitamin K dosing. Ann Emerg Med. 2000 Sep. 36(3):262-7. [Medline].

  12. Caravati EM, Erdman AR, Scharman EJ, et al. Long-acting anticoagulant rodenticide poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007. 45(1):1-22. [Medline].

  13. Papin F, Clarot F, Vicomte C, et al. Lethal paradoxical cerebral vein thrombosis due to suspicious anticoagulant rodenticide intoxication with chlorophacinone. Forensic Sci Int. 2007 Mar 2. 166(2-3):85-90. [Medline].

  14. Laposata M, Van Cott EM, Lev MH. Case records of the Massachusetts General Hospital. Case 1-2007. A 40-year-old woman with epistaxis, hematemesis, and altered mental status. N Engl J Med. 2007 Jan 11. 356(2):174-82. [Medline].

 
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