Rodenticide Toxicity Medication
- Author: Derrick Lung, MD, MPH; Chief Editor: Asim Tarabar, MD more...
Medication Summary
Give all patients with rodenticide overdose activated charcoal as soon as possible to prevent further absorption of ingested toxins.
If a coagulopathy is documented, institution of vitamin K therapy is suggested. However, again, in the absence of documented coagulopathy, empiric vitamin K therapy is contraindicated. Intentional exposure to an anticoagulant rodenticide for suicidal or other reasons may require substantial treatment with vitamin K for a protracted period of time, particularly in the face of exposure to one of the superwarfarins.
Antidotes, Other
Class Summary
Activated charcoal is empirically used to minimize systemic absorption of the toxin. It may be of benefit only if administered within 1-2 hours of rodenticide ingestion.
Neutralize the effects of the anticoagulant rodenticide-induced hemorrhages with vitamin K.
Activated charcoal (Actidose-Aqua, Char-Caps, Kerr Insta-Char)
Activated charcoal is used in the emergency treatment of poisoning caused by drugs and chemicals. A network of pores in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Activated charcoal does not dissolve in water.
This agent may be administered with a cathartic (eg, 70% sorbitol), except in young pediatric patients in whom electrolyte disturbances may be of concern. For maximum effect, administer activated charcoal within 30 minutes of poison ingestion.
Phytonadione (MEPHYTON)
There is no need to begin therapy unless the INR is greater than 2. No data exist to prove that such therapy prevents anticoagulation, although vitamin K therapy is shown to reverse anticoagulation once it develops. With long-acting anticoagulants, treatment may need to be at much higher doses and for a protracted period of time.
Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline]. [Full Text].
Decker WJ, Baker HE, Tamulinas SH, Korndorffer WE. Two deaths resulting from apparent parenteral injection of strychnine. Vet Hum Toxicol. Jun 1982;24(3):161-2. [Medline].
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). Aug 14 1982;285(6340):478. [Medline].
Spahr JE, Maul JS, Rodgers GM. Superwarfarin poisoning: a report of two cases and review of the literature. Am J Hematol. Jul 2007;82(7):656-60. [Medline].
La Rosa FG, Clarke SH, Lefkowitz JB. Brodifacoum intoxication with marijuana smoking. Arch Pathol Lab Med. Jan 1997;121(1):67-9. [Medline].
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].
Bruno GR, Howland MA, McMeeking A, Hoffman RS. Long-acting anticoagulant overdose: brodifacoum kinetics and optimal vitamin K dosing. Ann Emerg Med. Sep 2000;36(3):262-7. [Medline].
[Guideline] Caravati EM, Erdman AR, Scharman EJ, Woolf AD, Chyka PA, Cobaugh DJ, 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]. [Full Text].
Papin F, Clarot F, Vicomte C, Gaulier JM, Daubin C, Chapon F. Lethal paradoxical cerebral vein thrombosis due to suspicious anticoagulant rodenticide intoxication with chlorophacinone. Forensic Sci Int. Mar 2 2007;166(2-3):85-90. [Medline].
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. Jan 11 2007;356(2):174-82. [Medline].
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