Anticoagulant rodenticide poisoning: Clinical manifestations and diagnosis
- Diane P Calello, MD
Diane P Calello, MD
- Executive and Medical Director
- New Jersey Poison Information and Education System
- Department of Emergency Medicine
- New Jersey Medical School
- Rutgers Biomedical and Health Sciences
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic reviews the clinical manifestations and diagnosis of anticoagulant rodenticide poisoning.
The management of anticoagulant rodenticide poisoning and an overview of rodenticide poisonings other than anticoagulant rodenticides is provided separately. (See "Overview of rodenticide poisoning".)
Anticoagulant compounds are the most commonly used rodenticides in most of the world. The process of controlling rodent populations is imperative to human health but poses challenges when the rodenticide compounds used are also toxic to humans and domestic animals. The ideal rodenticide is highly toxic to rodents in small amounts but relatively nontoxic in small quantities to non-target species. The anticoagulant rodenticides best fit this criteria . Anticoagulant rodenticides came into use in the 1940s with the use of warfarin. The emergence of warfarin-resistant rats prompted the development of superwarfarins, or long-acting anticoagulants such as brodifacoum, bromadiolone, and chlorophacinone. Because of their availability, anticoagulant rodenticides are also the most common cause of rodenticide poisoning exposures reported annually in resource-rich countries such as the United States and the United Kingdom [2,3].
In the United States, brodifacoum is the most frequently used anticoagulant rodenticide ; however, global differences exist. In the United Kingdom, difenacoum, brodifacoum, and bromadiolone are most common . In the developing world, the use of warfarin rodenticides has led to tragic inadvertent exposures in newborns as well as the ingestion of contaminated foodstuff with resultant fatalities [6,7].
Throughout the world, the overwhelming majority of anticoagulant rodenticide exposures occur in young children, who generally ingest small volumes and have no significant coagulopathy [4,7-9]. However, patients with intentional or occupational exposures develop coagulopathy much more frequently.
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- FORMULATIONS AND CHEMICAL AGENTS
- MECHANISM OF ACTION
- TOXIC DOSE
- CLINICAL MANIFESTATIONS
- Physical examination
- Ancillary studies
- - Acute or chronic exposure
- - Occupational monitoring
- DIFFERENTIAL DIAGNOSIS
- ADDITIONAL RESOURCES
- SOCIETY GUIDELINE LINKS