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A Case of Rat Poisoning
54 year old female presented with:
Hemoptysis Of 5 Days Duration
Patient later also gave history of consumption
of medicine used for killing Rats
Multiple Ecchymoses over Chest both Lower Limbs
Hematoma noted around Tonsil region
CHEST: B/l clear air entry
P/A:Soft nontender,no organomegaly
MEDICAL h/o:HTN+,no DM,PTB,Hepatitis
SURGICAL h/o:non significant
ALLERGIC h/O:non significant
COMPLETE BLOOD COUNT:
RENAL FUNCTION TEST:
Prothrombin Time(PT): >120s
Liver Function Test
Chest X-ray Report
Coagulation Abnormalities? Cause
Hemoptysis of unknown origin
Chronic Liver Disease
Rat Poisoning (Coagulation Disorder)
Transfusion of FFP, Whole BLOOD
Inj Vitamin K
Antibiotics and other supportive measures
Coagulation Profile after Treatment
Composition of Rat Poisoning( Rodenticide)
COUMARINS First Generation:Warfarin,Coumatetralyl
Second Generation : Difenacoum,Bromadilolone
1,3 INDANDIONES Diphanicone,Pindone
INDIRECT Sometimes, anticoagulant rodenticides are potentiated
by an antibiotic or bacteriostatic agent. The aim of this
association is that the antibiotic suppresses intestinal
symbiotic microflora, which are a source of vitamin K
These are generally Chronic(death usually occurs
after few weeks after consumption of lethal
These acts by blocking Vitamin K cycle leading to
inability to produce coagulation factor II,VII.IX,X.
Phosphide Used Rodentocide
Metal phosphides have been used as a
means killing of rodents and are
considered single-dose fast acting
rodenticides (death occurs commonly
within 1–3 days after single bait
ingestion). A bait consisting of food and a
phosphide (usually zinc phosphide) is left
where the rodents can eat it.
Calciferols (vitamins D), cholecalciferol (vitamin D3) and
ergocalciferol (vitamin D2)
They affect Calcium and Phosphate homeostasis.
On larger doses consumption causes Hypervitaminosis.
Hypercalcemia tends to affect Cardiac Muscle(affecting
Contractility),Blood Vessels(leading to bleeding due to
capillary damage) and Possibly ARF.
They are also synergetic with anticoagulants.
A suggested algorithm for the management of a warfarin- treated patient whose international
normalized ratio (INR) exceeds 4.
Garcia D A , and Crowther M A Circulation. 2012;125:2944-
Copyright © American Heart Association, Inc. All rights reserved.
The prothrombin time (PT) and its derived measures of
prothrombin ratio (PR) and international normalized
ratio (INR) are measures of the extrinsic pathway of
coagulation. This test is also called "ProTime INR" and
What is the role of Calcium Gluconate in the
treatment, since the composition of Rodentocide also
may consists of excessive Calcium?
Vitamin K dependent coagulation
factor(II,VII,IX,X),can it be tranfused directly?
What Should be the target INR in management of this
Random Blood Glucose Level is high is it not worthy
sending Fasting & PP Blood Sugar?