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Rat poisoning management
- 2. Any Substance thatis used to kill rats, mice and other rodent pests. In India and in many parts of the world, huge quantity of grains is eaten up and destroyed by rats. Hence for preservation of grains use of rodenticidal agents has become imperative. Single feed baits are chemicals ,sufficiently dangerous enough to kill the rats at its first dose. Rodenticides are controversial due to secondary poisoning due to their risk to humans and pets.
- 3. These ratpoisons have recently become a common means of self poisoning in Northern India , with a mortality rate of 60%. Poisoning may be: -Suicidal -Accidental -Homicidal Modes of poisoning: -Ingestion -Inhalation -Dermal contact
- 4.
- 5. Inorganic preparations: Bariumcarbonate, phosphorous ,Thallium , Zn phosphide Organic preparations: Flouro acetate compounds Convulsants: Strychnine Anti coagulants: -First generation : warfarin , coumatetrayl -Second generation : Brodifacoum , Difenacoum Others: Arsenic , Bromethalin , Endrin , Sodium fluoro acetate and Zyklon.
- 6. Zinc phosphide: -It is a single dose fast acting rodenticide. -Death occurs with in 1-3days after ingestion. -MOA: Acid in the stomach reacts with the phosphide to yield toxic phosphine gas which is a potent pulmonary toxicant. Calciferols: -MOA: On ingestion in toxic doses these affect calcium and phosphate homeostasis causing hypercalcemia.
- 7. -On accumulation instomach , kidney , lungs , blood vessels and heart are all calcified/mineralised. -It has a synergistic effect with anticoagulant , thereby increasing the chances of death and decrease in the time involved. ANTI COAGULANTS: -After ingestion of lethal dose , it effectively blocks the vit-k cycle , resulting in inability to produce essential blood clotting factors mainly factors II and VII.
- 8. - massive toxicdoses of 4-hydroxycoumarin cause damage to tiny blood vessels , increasing their permeability , causing diffuse Internal Bleeding. -These effects are gradual , developing over several days. -This is the preferred type of rat bait , as the antidote is available i.e, Vit-K.
- 9. WITH ZINCPHOSPHIDE: -Via Inhalation : Cough, Nausea ,Vomiting,Headache Fatigue. -Via Ingestion: Abdominal pain , Cough , Diarrhoea , Dizziness , Shortness of breath , Unconsciousness , Nausea , Vomiting Uncoordinated movements.
- 10. Nausea ,Vomiting , Anorexia , Fatigue , Itching and Weakness. Acute Intoxication: Polyneuropathy. Chronic Intoxication: Extreme depression , Apathy , Confusion , Fatigue.
- 11. Do nothave onset symptoms , which might manifest days later. Haematuria Bloody diarrhoea Extensive Bruising Epistaxis Haematemesis Low Blood pressure Confusion , Lethargy , Altered mental status Shock With Warfarin: Pin point Purplish red spots
- 12. WITH BARIUM:Nausea , Weakness , Abdominal pain. WITH THALLIUM: Acute GI distress , Anorexia , Myalgias , Painful neuropathy and hair loss. WITH STRYCHNINE: Anxiety , Generalized seizure like appearance without loss of consciousness , Muscle twitching , Facial grimacing. WITH ARSENIC: Nausea , Vomiting , Bloody diarrhoea and garlic taste in mouth.
- 13. APPROACH CONSIDERATIONS: •Complete blood count • PT • INR • Activated PTT • BT • Platelet count • Lab verification of Brodifacoum , Difenacoum. • CPK • LA • Blood test for arsenic & Thallium
- 14. • Abdominal PlainFilm Radiography • Detecting phosphine in exhaled air/stomach aspirate using either a silver nitrate impregnated strip or specific phosphine detector tube is diagnostic. • But Gas chromatography provides the most sensitive indicator.
- 15. Always lookfor a container , so that the specific product can be determined. Decontamination may be necessary.
- 16. Secure airwayand place IV lines in Haemodynamically unstable patients. ACTIVATED CHARCOAL is used as soon as possible to prevent further systemic absorption of ingested toxin. GI EVACUATION in cases of huge over dosage and in which the patient presents early to an emergency facility. Inducing Vomiting is likely only with in 1-2hrs after ingestion.
- 17. ZINC PHOSPHIDE: -Supportivetherapy remains the only available form as there is no specific antidote. -Gastric lavage with vegetable oil to reduce the release of toxic phosphine. -Patients with severe respiratory compromise require endotracheal intubation for ventilatory support. -Severe haemolysis from phosphine gas may require exchange transfusion of RBCs.
- 18. If nocoagulopathy is found in the setting of an anti- coagulant exposure ,prophylactic treatment with Vit-K is absolutely contraindicated. If a coagulopathy is documented , Vit-K therapy is suggested. Patients who present with life threatening haemorrhage , in addition to Vit-K, Prothrombin complex conc. and/or fresh frozen plasma may be needed to reverse anti coagulation.