II. Background

  1. Sodium fluoroacetate has since 1985, restricted use in the U.S. on livestock collars as a predacide (toxic to predators, such as coyotes)
  2. Sodium fluoroacetate was originally used in U.S. as a rodenticide and to kill coyotes from 1940 to 1985
  3. Fluoroacetate is found naturally in Gastrolobium flowering plants of Australia, as well as other plant species in New Zealand, Brazil and Africa
  4. Sodium fluoroacetate is highly toxic to mammals including humans
    1. Fluoroacetate is structurally similar to acetate, entering the Kreb Cycle with its derivative tightly binding aconitase, and blocking further activity

III. Pharamacokinetics

  1. Oral lethal dose >2 mk/kg
    1. Rapid absorption
    2. Also toxic via inhalation or absorption via broken skin

IV. Symptoms

  1. Gastrointestinal
    1. Nausea or vomting
    2. Abdominal Pain
  2. Respiratory
    1. Decreased respiratory effort
  3. Cardiovascular
    1. Hypotension
    2. QT Prolongation
    3. Ventricular Tachycardia
  4. Neurologic
    1. Agitation
    2. Cerebellar dysfunction
    3. Seizure
    4. Altered Mental Status (coma)
  5. Metabolic
    1. Hypocalcemia
    2. Hypomagnesemia
    3. Acidosis

V. Labs

VI. Management

  1. Activated Charcoal in early presentations (first few hours) if no airway compromise or other contraindications
  2. Supportive care
    1. Supplemental Oxygen as needed
    2. Blood Pressure support
      1. Intravenous Fluids
      2. Norepinephrine in refractory Hypotension
    3. Seizure
      1. Benzodiazepines
      2. Barbiturates
      3. Propofol
    4. Electrolyte replacement for deficits
      1. Calcium Gluconate
      2. Magnesium Sulfate
    5. Other experimental measures to consider
      1. Intravenous Lipid Emulsions
      2. Methylene blue
  3. Disposition
    1. May discharge patients who remain asymptomatic at 4 hours
    2. Admit all symptomatic patients

VII. Resources

  1. Sodium fluoroacetate (Wikipedia)
    1. https://en.wikipedia.org/wiki/Sodium_fluoroacetate

VIII. References

  1. Tomaszewski (2022) Crit Dec Emerg Med 36(12): 32

Images: Related links to external sites (from Bing)

Related Studies