Anticoagulant rodenticide poisoning: Management
- 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 management of anticoagulant rodenticide poisoning.
The clinical manifestations and diagnosis of anticoagulant rodenticide poisoning and an overview of rodenticide poisonings other than anticoagulant rodenticides is provided separately. (See "Anticoagulant rodenticide poisoning: Clinical manifestations and diagnosis" and "Overview of rodenticide poisoning".)
INDICATIONS FOR MEDICAL EVALUATION
Not all ingestions of anticoagulant rodenticides warrant medical evaluation. The need for medical evaluation is determined by the clinical circumstances and the toxicity of the exposure. We consider a nontoxic dose to be <1 mg. However, with most anticoagulant rodenticide ingestions, the exact amount is difficult to determine and the clinical circumstances and type of formulation ingested is used to determine if an exposure is potentially toxic. We encourage determination of toxicity and need for evaluation in consultation with a regional poison control center, whenever possible. (See 'Additional resources' below.)
Our approach to patients after exposure to long-acting or warfarin anticoagulant rodenticides are based upon the guideline published by the American Association of Poison Control Centers as follows :
●Emergency department evaluation – Immediate referral to an emergency department, regardless of estimated dose ingested or exposure, is warranted for all of the following patients:
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- INDICATIONS FOR MEDICAL EVALUATION
- Nontoxic exposures
- Toxic exposures
- - Gastrointestinal decontamination
- - No coagulopathy
- - Coagulopathy but no bleeding
- - Coagulopathy and active bleeding
- - Elimination enhancement
- Intentional exposures
- ADDITIONAL RESOURCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS