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Rat poison

Rat Poisoning

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Rat poison

  1. 1. A Case of Rat Poisoning
  2. 2. 54 year old female presented with: C/O: Dizziness Hemoptysis Of 5 Days Duration Epistaxis Vertigo Facial Swelling
  3. 3. Patient later also gave history of consumption of medicine used for killing Rats
  4. 4. ON EXAMINATION Multiple Ecchymoses over Chest both Lower Limbs Hematoma noted around Tonsil region Jaundice:Mild Anemic:Mild LN:Nil Cyanosis:Nil Clubbing:Nil Oedema:Nil Dehydration:Nil VITALS: P:80/min BP:100/70mmHg R/R:20/min T:36.6c
  5. 5. CHEST: B/l clear air entry CVS:S1.S2.M0 P/A:Soft nontender,no organomegaly
  6. 6. MEDICAL h/o:HTN+,no DM,PTB,Hepatitis SURGICAL h/o:non significant ALLERGIC h/O:non significant PERSONAL h/o:Alcoholic+
  7. 7. INVESTIGATIONS COMPLETE BLOOD COUNT: WBC:17.32X10*9/L(N=77.9%),L(14.1%), RBC:2.44X10*12/L,HB:203g/L,HCT:60.2%,MCV:101.2fl PLT:322X10*9/L RENAL FUNCTION TEST: Urea:6.8mmol/L,Cr:122umol/L Na:140mmol/L,K:3.7mmol/L
  8. 8. Coagulation Profile Prothrombin Time(PT): >120s APTT:>180s INR>10 Thromboplastin Time:16.2s Fibrinogen:4.26g/L D Dimer:Negative
  9. 9. Liver Function Test
  10. 10. Biochemistry Investigations
  11. 11. Urine R/E
  12. 12. Chest X-ray Report
  13. 13. Differential Diagnosis Coagulation Abnormalities? Cause  Hemoptysis of unknown origin  WARFARIN Toxicity  Chronic Liver Disease  Moderate Anemia  Hemophilia
  14. 14. DIAGNOSIS Rat Poisoning (Coagulation Disorder)
  15. 15. TREATMENT Transfusion of FFP, Whole BLOOD Inj Vitamin K Antibiotics and other supportive measures
  16. 16. Coagulation Profile after Treatment
  17. 17. TREATMENT
  18. 18. LITERATURE
  19. 19. Composition of Rat Poisoning( Rodenticide) CLASS(Anticoagulant) EXAMPLES 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
  20. 20.  These are generally Chronic(death usually occurs after few weeks after consumption of lethal dose,rarely sooner). These acts by blocking Vitamin K cycle leading to inability to produce coagulation factor II,VII.IX,X.
  21. 21. 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. AVAILABLE PHOSPHIDES:  ALUMINIUM PHOSPHIDES  MAGNESIUM PHOSPHIDES  ZINC PHOSPHIDES
  22. 22. 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.
  23. 23. 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- 2947 Copyright © American Heart Association, Inc. All rights reserved.
  24. 24. 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 "PT/INR".
  25. 25. DISCUSSIONS  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 patient?  Random Blood Glucose Level is high is it not worthy sending Fasting & PP Blood Sugar?
  26. 26. Reference http://circ.ahajournals.org/content/125/23/2944.full www.aapf.org Wikipedia
  27. 27. THANK YOU

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