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Anticoagulant rodenticides poisoning

Rat killer poisoning; Rodenticide poisoning

Anticoagulant rodenticides are poisons used to kill rats. Rodenticide means rodent killer. An anticoagulant is a blood thinner.

Anticoagulant rodenticide poisoning occurs when someone swallows a product containing these chemicals.

This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

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Poisonous Ingredient

Poisonous ingredients include:

• 2-isovaleryl-1,3-indandione
• 2-pivaloyl-1,3-indandione
• Brodifacoum
• Chlorophacinone
• Coumachlor
• Difenacoum
• Diphacinone
• Warfarin

Note: This list may not be all-inclusive.

Where Found

These ingredients may be found in:

• D-Con Mouse Prufe II, Talon (brodifacoum)
• Ramik, Diphacin (diphacinone)

Note: This list may not be all-inclusive.

Symptoms

Symptoms include:

• Blood in the urine
• Bloody stools
• Bruising and bleeding under the skin
• Confusion, lethargy, or altered mental status from bleeding in the brain
• Low blood pressure
• Nosebleed
• Pale skin
• Shock
• Vomiting blood

Home Care

DO NOT make a person throw up unless told to do so by poison control or a health care professional.

Before Calling Emergency

Determine the following information:

• Person's age, weight, and condition
• The name of the product (ingredients and strengths, if known)
• Time it was swallowed
• How much was swallowed

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

What to Expect at the Emergency Room

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Blood and urine tests will be done. The person may receive:

• Airway and breathing support, including oxygen. In extreme cases, a tube may be passed through the mouth into the lungs to prevent the person from breathing in blood. A breathing machine (ventilator) would then be needed.
• Blood transfusion, including clotting factors (which help your blood clot), and red blood cells.
• Chest x-ray.
• ECG (electrocardiogram, or heart tracing).
• Endoscopy -- a camera down the throat to see the esophagus and stomach.
• Fluids through a vein (IV).
• Medicines to treat symptoms.
• Medicine (activated charcoal) to absorb any remaining poison (activated charcoal may be given only if it can be done safely within one hour of poison ingestion).
• Laxatives to move the poison through the body more quickly.
• Medicine (antidote) such as vitamin K to reverse the effect of the poison.

Outlook (Prognosis)

Death may occur as late as 2 weeks after the poisoning as a result of bleeding. However, getting the right treatment most often prevents serious complications. If blood loss has damaged the heart or other vital organs, recovery may take longer. The person may not fully recover in these cases.

References

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. PMID: 17357377 pubmed.ncbi.nlm.nih.gov/17357377/.

Thomas SHL. Poisoning. In: Penman ID, Ralston SH, Strachan MWJ, Hobson RP, eds. Davidson's Principles and Practice of Medicine. 24th ed. Philadelphia, PA: Elsevier; 2023:chap 10.

Welker KL, Thompson TM. Pesticides. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 152.

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Review Date: 10/6/2022  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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