II. Background
- Neurotoxic, non-Anticoagulant rodenticide in Diphenylamine category of agents
- Pale, odorless, crystalline solid
- Greater use as Anticoagulant rodentacides are phased out due to resistance
- Available in multiple low concentration forms (blocks, pellets at 0.01%) as well as high concentration forms (7.5%)
III. Pathophysiology
- Exposures
- Ingestions and toxicity in pets (dogs, cats) has been more common than toxicity in humans
- Accidental, unintentional pediatric ingestion
- Typically low dose ingestion without toxicity
- Intentional ingestion for Suicide attempt in adults
- Potentially lethal
- Mechanism (effects may be delayed up to 24 hours)
- Cerebral Edema
- Oxidative Phosphorylation is uncoupled (in CNS mitochondria), resulting in decreased ATP
- Nerve Impulse conduction is interrupted
-
Pharmacokinetics
- Asymptomatic at doses <0.1 mg/kg
IV. Findings
- Cardiovascular
- Gastrointestinal
- Hematologic
- Mild bleeding (mild Anticoagulation effects)
- Neurologic
- Agitation
- Tremors
- Lethargy
- Myoclonic Jerks
- Seizures
V. Differential Diagnosis
VI. Labs
- See Altered Level of Consciousness
- See Unknown Ingestion
- Standard toxicology labs (e.g. Bedside Glucose, Acetaminophen level, Salicylate level)
- Consider INR (if Anticoagulant rodenticide ingestion suspected)
VII. Management
- See Unknown Ingestion
- ABC Management
- Activated Charcoal if recent ingestion
- Seizures
- Cerebral Edema
- Severe ingestions
- Consider Intralipid emulsion infusion
- Disposition
- Low dose ingestions may be discharge home if asymptomatic
- Medically observe intentional ingestions up to 24 hours
- Admit all symptomatic ingestions
VIII. References
- Tomaszewski (2021) Crit Dec Emerg Med 35(6): 28