Rodenticide Poisoning Research Articles

Study on outcome of N-acetylcysteine in rodenticide poisoning cases in a rural tertiary care teaching hospital

Background: Rodenticide is one of the pesticides and heterogeneous substances used to kill rats. Rodenticide poisoning is the major health problem in Asian countries, particularly mode of self-poisoning, prevalent in India. It causes hepatotoxicity and no antidote has been found. N-acetylcysteine (NAC) is a powerful antioxidant and used in the treatment of acetaminophen-induced hepatotoxicity. The aim of the study is to find the outcome of use of NAC in rodenticide poisoning. The main objectives of this study were to determine the role of NAC in liver impairment rodenticide poisoning patients. Methods: A record based observational study was conducted for the period of 3 months from August 2019 to October 2019 at Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar, Tamil Nadu. Data were collected according to the proforma designed and results were analyzed using standard methods.Results: Out of 50 patients, 21 (42%) were males and 29 (58%) were females. Age group between 21-30 years contributes the highest 20 (40%). Majority of type of rodenticide compound consumed by patients were paste 29 (58%) and less than four hours 34 (68%) patients were admitted. Patients with abnormal liver functions were tested, serum glutamic oxaloacetic transaminase/ aspartate aminotransferase -12 patients, 7 treated with NAC. serum glutamic pyruvic transaminase/ alanine aminotransferase - 9 patients, 2 treated with NAC. 37 (74%) were recovered out of 50 (100%), among them 28 (56%) treated with NAC.Conclusions: In liver impairment rodenticide poisoning patients, early use of NAC shows a significant result and the rate of recovery is also high.

Rodenticide Poisoning: Critical Appraisal of Patients at a Tertiary Care Center.

ABSTRACTImportanceRodenticide poisoning is a common occurrence in India. Of the different classes of rodenticides available, yellow phosphorus is considered highly toxic. There are scarce epidemiological data regarding the ingestion of yellow phosphorus in the subcontinent.ObjectivesThis study aimed to identify the clinical profile of rodenticide-poisoned patients and delineate mortality predictors.DesignProspective observational study.Setting and participantsStudy was conducted at the Department of Internal Medicine, Government Villupuram Medical College and Hospital. All adult inpatients with a history of rodenticide poison exposure were eligible participants. A total of 99 patients completed the study protocol.Main outcomeSurvival with or without morbidity and death.ResultsIn all, 90.91% of patients consumed the paste formulation of rodenticide [yellow phosphorus (67.2%) and yellow phosphorus + zinc phosphide (24%)].The time to resuscitation showed significance to mortality. Survival rate among patients instituted gastric decontamination within 2 hours of exposure (97.87%) was significantly higher than those who were not (84.62%) (p = 0.033). The clinical picture revealed conspicuous absence of signs and symptoms during the first 24 hours. In all, 72.73% (n = 72) manifested with toxidrome after a lag period of 24–36 hours (range 18–72 hours). The dominant clinical manifestations included abdominal pain (52.53%), jaundice (22.21%), coagulopathy (15.15%), encephalopathy (10.10%), shock (10.10%), acute kidney injury (AKI; 7.08%), and multi-organ failure (17.17%). Laboratory data showed elevated aspartate transaminase (AST; 48.47%), alanine aminotransferase (ALT; 49.50%), bilirubin levels (22.21%), metabolic acidosis (10.12%), serum creatinine (7.08%), prothrombin time prolongation (PT/INR; 15.15%), and activated partial thromboplastin time (aPTT) (3.30%). The mortality was 9.1% (n = 9) of which 77.78% (n = 7) died of fulminant hepatic failure. The mean time for death was 4.22 days since exposure (range 2–8 days).ConclusionRodenticide poisoning in Southern India is dominated by yellow phosphorus. In this study, we identified delayed resuscitation, jaundice, hepatic encephalopathy, elevation of AST and ALT to >1000 IU/L, metabolic acidosis, and refractory shock as reliable predictors of bad outcome in this patient population. The common mode of death was fulminant hepatic failure.RelevanceRodenticide poisoning ranks second in mortality hierarchy at our institute, and systematic analysis of this patient population is an urgent need.How to cite this articleGopalakrishnan S, Kandasamy S, Iyyadurai R. Rodenticide Poisoning: Critical Appraisal of Patients at a Tertiary Care Center. Indian J Crit Care Med 2020;24(5):295–298.

PNS7 ROLE OF N-ACETYL CYSTEINE IN RODENTICIDE POISONING: A SYSTEMATIC REVIEW AND META-ANALYSIS

The role of N-Acetyl cysteine (NAC) in Rodenticide poisoning hasn’t been well established due to mixed results from various studies and lack of proper treatment guidelines. We aimed to evaluate the efficacy of NAC in the treatment of rodenticide poisoning.

SAT-451 PLASMA EXCHANGE IN YELLOW PHOSPHORUS POISONING-A SINGLE CENTRE STUDY

Yellow phosphorus(YP) is one of the causes of rodenticide poison in developing countries especially India, due to easy availability, cheap cost & easy accessibility. Liver transplantation is the treatment of choice in patients with fulminant hepatic failure(FHF). Here we present our experience in dealing this poison with plasma exchange(PE) as the modality of treatment when liver transplantation is not an easily available option. In this prospective study, all patients of YP poisoning who had fulminant hepatic failure requiring plasma exchange were taken into the study. The study period was from January 2017 to June 2019. Clinical presentation, co-morbidities, poison form & amount, day of hospitalisation, day of initiation of plasma exchange, hepatic encephalopathy grade & baseline characteristics were noted. FHF was defined according to O'Grady/King's College criteria. History of ethanol consumption, prior liver disease documented. Laboratory data including Liver function test(LFT), Renal function test, coagulation parameters were noted serially before & after plasma exchange. Outcomes were documented as recovered or not recovered. Continuous variables were expressed as mean± Standard deviation or median and range according to test for normal distribution by using Shapiro-Wilk test. Friedman test was applied to check the continuous parameters at three different point of time. Independent-t test was used for statistical analysis where-ever required. A p-value of < 0.05 was considered statistically significant. A total of 10 patients were included in the study. 6 were males(60%) & 4 females(40%). Median age was 24.5 yrs. Seven patients(70%) recovered completely, 3 patients(30%) didn't recover. Among those 3 patients, one was referred for liver transplantation, one expired and one more had persistent liver dysfunction. 90% of patients had deliberate YP consumption, especially in paste form(90%). Among 7 patients who consumed < 20 gm of YP, 6 recovered(85.7%); whereas only one recovered(14.3%) among the rest who consumed ≥ 20 gm. 40% of patients received 2 sessions of PE, 30% received 5 sessions, 20% received 3 sessions and remaining 10% received 4 sessions. Mean sessions of PE was 3.5(2-5). For recovery, the mean day of hospitalization was 3.57 days(p=0.019) and for initiation of PE was 4.86 days(p=0.016) after consumption of YP. Peak median total bilirubin (mg/dl) prior to PE was 9.29 and decrease after PE was 2.76(p=0.005). Mean SGOT(IU/L) decreased from 819.8 to 61.4(p=0.005); SGPT(IU/L) from 457.8 to 65.8(p=0.005) ;INR from 3.24 to 1.4(p=0.008); PT(s) declined from 79.38 to 21.48(p=0.013);APTT(s) from 56.44 to 31.87 (p=0.007) post PE. Diabetes Mellitus & Hypertension didn't have any effect on the outcome. Out of 3 patients who had history of ethanol consumption, 2 recovered. The outcome of the patient depends on the amount of YP consumed; the day of hospitalization & initiation of PE from the day of YP consumption. Earlier the hospitalization &earlier the PE; more are the chances of recovery. Our experience suggests that PE is an effective approach for YP poisoning with 70% survival rate with improvement in LFT & coagulation parameters.

A retrospective study of clinical profile and outcome of patients with rodenticide poisoning in tertiary care teaching hospital, Mandya Karnataka, India

Background: Poisoning is the major health problem in developing countries like India. Rodenticides are one of the commonest substances used for poisoning in India. Rodenticides are the substances used to kill rats. They differs from chemical composition and toxicity profile. Prognosis mainly depends on chemical content of poison.Methods: This retrospective record-based study was conducted between October 2018 to September 2019 at MIMS tertiary care teaching hospital, Mandya, Karnataka, India. Data regarding age, sex, marital status, occupation, socioeconomic status, type of poison, route of exposure, clinical presentation, complications and outcome of poisoning and associated comorbid conditions were collected from the hospital records and documented in the pre-structured proforma. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Out of 126 study subjects, 77 (61.11%) were female, 49 (38.89%) were male. Most common age group was 21 to 30 years (45.23%), followed by 31 to 40 years (26.19%) group. Most common poison was zinc phosphide (52.39%), followed by yellow phosphorous (30.16%). Mode of poisoning was suicidal (94.4%) followed by accidental (5.6%).Most common symptom at presentation was nausea, vomiting (62.6%) followed by pain abdomen (52.4%).Most common complication was hepatitis 34 (26.98%) patients, followed by hepatic encephalopathy in 6 (4.76%) and cardiogenic shock in 6 (4.76%) patients. Total mortality was 8 (6.3%).Conclusions: Among rodenticides zinc phosphide was most common consumed poison in present study. Yellow phosphorous was most toxic poison and Aluminium phosphide was most lethal poison. Even though there is no specific antidote, early symptomatic treatment is the key in reducing the mortality.

A California Without Rodenticides: Challenges for Commensal Rodent Management in the Future

Author(s): Quinn, Niamh; Kenmuir, Sylvia; Krueger, Laura | Abstract: Rodenticides are an essential tool in the integrated pest management (IPM) of infestations of commensal rodents. With the introduction of Assembly Bill 2422 California Natural Predator Protection Act, the State of California is potentially facing a future with serious restrictions on the use of anticoagulant rodenticides to manage commensal rodents in urban areas. Assembly Bill 2422 has been proposed to protect predators from rodenticide poisoning and seeks to significantly restrict the application of first and second generation anticoagulant rodenticides for use in many urban and no-urban areas of California. Exclusion and cultural practices, such as landscape management and sanitation, are important and successful tools for managing rodent populations. However, quick and efficient control of commensal rodent infestations often necessitates the use of rodenticides. While rodenticide is an important tool, exposure of wildlife to anticoagulant rodenticides has been evident for many years in the state of California. When rodents are consumed by predators, second generation anticoagulant rodenticides can be detected as residues in the livers of predators. Many species of animals are documented as having succumbed to rodenticide toxicosis, however the effects of chronic, sub-lethal exposure to predators are not well understood. This paper will discuss the current and proposed changes to rodenticide legislation in California, impacts of the legislation on communities across California, and gaps in research preventing the adoption of evidence-based best management strategies for rodent control. In order to improve the success of commensal rodent control programs in California, effective strategies for rodent management must be developed.

Novel inner filter effect-based fluorescence immunoassay with gold nanoclusters for bromadiolone detection in human serum

Bromadiolone (BRD) is a widely used second-generation rodenticide and BRD poisoning in humans is relatively common. However, few rapid diagnostic methods for BRD poisoning are currently available. In this study, a highly sensitive and specific fluorescence immunoassay was developed for the rapid detection of BRD in human serum. Briefly, two novel BRD haptens were synthesized, a sensitive and specific mAb for BRD (15C1) was produced. We then incorporated mAb 15C1 as a detection reagent, and gold nanoclusters (AuNCs) as a fluorescent probe into an alkaline phosphatase-based competitive fluorescence immunoassay. The sensitivity of the immunoassay was significantly improved by introducing the fluorescence signal of the AuNCs through the facile inner-filter effect strategy. Our fluorescence immunoassay exhibited high specificity and achieved a limit of detection of 0.047 ng/mL for BRD, which was >10 times better than the corresponding standard enzyme-linked immunosorbent assay using the same immune reagents. The recoveries in spiked human serum were 77.9%–85.6% with coefficients of variation (CVs) of 3.6%–9.8%. There was a good correlation (R2 = 0.987) between the fluorescence immunoassay and ultra-performance liquid chromatography-tandem mass spectrometry. The fluorescence immunoassay could provide a valuable clinical tool for the rapid diagnosis of BRD poisoning.

45. Liver Transplant in Acute Liver Failure – Looking Back

Background and Aims: Acute liver failure (ALF) although relatively uncommon, tends to affect young individuals and is the leading cause for emergency liver transplantation (LT) the world over. We carried out this study to look at the disease spectrum and to identify the possible predictors of poor outcomes after LT. Methods: We analyzed retrospectively data of 70 cases (median age 24yrs, M:F 1:2) of LT performed for ALF at our institution from April 2007 to April 2017 (out of total of 560 (12%)). Results: The etiology was identified in 53 cases [HAV (n = 15), HBV(n = 5), HEV (n = 1), ATT induced n= (6), Acute Wilson's (n = 3), Autoimmune (n = 5) and Yellow Phosphorous (YP), rodenticide poisoning (n = 16)] and remaining 17 cases were of indeterminate etiology. Etiology differed between adults (>12 years, n = 61) and children (n = 9). Whilst the most common etiology in adults were indeterminate followed by HAV and YP poisoning, equal incidence of indeterminate, acute Wilson's and ATT induced liver failure were seen among children. Upon meeting King's College criteria, 69 had live donor LT (55 Right lobe grafts, 3 left lobe grafts, 4 lefts lateral segment grafts and 5 cases were APOLT) and 1 deceased donor LT. Post-operative morbidity seen were bile leak (23%), sepsis (17.3%), ACR (14.4%), AKI (13%), graft dysfunction (5%), HAT (2.8%) and PVT (1.4%). Overall mortality was 36% (50% in the pediatric and 34% in adults), vast majority of which (92%) occurred within 30 days of transplant. The major cause of mortality was sepsis with MODS. Risk factors for mortality on univariate analysis included donor age >35yrs, pre-transplant renal dysfunction, Grade 4 encephalopathy and hepatitis A, YP poisoning and seronegative etiology. However, on multivariate analysis, only grade IV HE was a significant risk factor for post-transplant mortality. Over a median follow up of 6.17yrs, 60.2% of perioperative survivors are leading a normal life. Most of these mortalities (81.2%) occurred in the immediate post-operative period (within 30 days). Conclusions: LT for ALF carry high mortality (36%) in those presenting with Grade 4 encephalopathy. Nevertheless, if they survive the perioperative period, long term survival is excellent. The authors have none to declare.

Chloralose analysis in a criminal case

To present, in a murder case, toxicological findings of chloralose in non-biological and biological matrices including hair. A 28-year-old woman was found dead in her bedroom. The same morning her former flatmate, worried because she had had no news from her friend, went to the victim's home where she was met by a male friend of the victim who forced her to drink a paste-like, bitter liquid at knifepoint. After ingestion, she immediately felt very tired and almost incapable of moving. She eventually managed to escape from the flat. The suspect was arrested some days later. He admitted strangling the deceased victim and trying to kill himself with a type of rat poison called Caussade ® . To our knowledge, this company only sells two products on the French market: chloralose and brodifacoum. The autopsy confirmed cause of death by strangulation associated with massive bronchial inhalation of vomit. The judge ordered a toxicological investigation of blood, urine and hair (collected 3 months after the murder) from the surviving victim (former flatmate), hair from the perpetrator (taken 6 weeks after his arrest), autopsy samples from the deceased victim and various different materials that were collected at the scene (powder, liquid, a cup and drinking glasses). Hair strands were decontaminated twice and then segmented as appropriate to cover the period of interest. Each segment of hair was cut into small pieces (< 1 mm) followed by a liquid-liquid extraction process and analysed by LC-MS/MS. Biological fluids and collected materials were submitted for GC-MS, LC-DAD and LC-MS/MS analysis. Specific investigations focused on chloralose and brodifacoum. The analyses show the following main results ( Table 1 ). Toxicological analysis confirmed that the rodenticide poison used by the perpetrator to try and commit suicide and to poison both victims was composed exclusively of chloralose. In particular, hair analysis for chloralose (for which there is very limited data within the scientific literature), allowed us to unequivocally confirm the perpetrator's statements and provide useful input to the police investigation. The symptoms observed in the surviving victim are in accordance with an oral absorption of chloralose. Concerning the deceased victim, the concentrations of chloralose measured were much lower than those encountered in other non-fatal and fatal poisoning cases, for which postmortem blood concentrations from 5 to over 100 μg/mL have been observed. Despite the probable low exposure to this pesticide and given that the main cause of death is known, the potential contributory role of chloralose, which can cause vomiting and lead to bronchial inhalation, cannot be totally ruled out.

A retrospective study of clinical profile and outcome of patients with rodenticide poisoning in a tertiary care hospital

Background: In developing countries, the substances most commonly used for self-poisoning are agricultural pesticides including rodenticides. Authors aimed to assess the clinical status and outcomes of patients with rodenticide poisoning in a tertiary care hospital.Methods: This retrospective record-based study was carried over three years. Apart from demographic details, information regarding the time of ingestion, nature and amount of the compound. Other details included clinical features, complications, treatment and outcome of the patient. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results: Of the 120 study subjects, 85 (93.40%) participants self-harmed, 2 (2.20%) were homicidal, and 4 (4.40%) had accidentally consumed the rodenticide. About 52 (32.70%) participants had vomiting, 34 (21.38%) had giddiness, 32 (20.13%) participants had abdominal pain. On the whole, 85 (73.28%) participants recovered, 23 (19.83%) participants had absconded, 6 (5.17%) participants had referred and 2 (1.72%) of them expired.Conclusions: Phosphorous compounds, particularly yellow phosphorous are the most lethal rodenticides followed by Coumadin. Symptomatic management of the patients at the earliest possible time is the mainstay, as there are no specific antidotes for any of the compounds.

Rodenticide poisoning: Literature review and management

Rodenticide is a broad term, and there are a wide variety of such compounds depending on the geographical region and availability. These compounds differ in their chemical composition, mechanism of action, toxic doses, and lethal effects. Coumarins, aluminum phosphide, zinc phosphide, and yellow phosphorous are the most easily available and commonly used rodenticides for deliberate self-harm. Aluminum phosphide poisoning is rapidly fatal, whereas yellow phosphorous poisoning too is associated with a high mortality within 1–2 weeks of consumption.

Profile ofpatients with rodenticide poisoning and pictorial confirmation of rodenticideas quick means of identification: A study inatertiary level Hospital

Profile ofpatients with rodenticide poisoning and pictorial confirmation of rodenticideas quick means of identification: A study inatertiary level Hospital

Clinical profile and outcome of rodenticide poison in Hassan institute of medical science, Hassan

Clinical profile and outcome of rodenticide poison in Hassan institute of medical science, Hassan

Case Study of Clinical Profile and Outcome of Rodenticide Poisoning

Case Study of Clinical Profile and Outcome of Rodenticide Poisoning

Aluminium phosphide induced liver injury – The “DILI” Dilemma

Introduction: Phosphide containing rodenticide poisoning is a recognized cause of acute liver failure. Its treatment has a myriad of obstacles and treatment modalities range from medical (N-acetyl cysteine) to surgical (liver transplantation). We report 5 cases of Drug induced Liver Injury (DILI) following ingestion of Phosphide containing rodenticide for suicidal purpose and their outcomes. Methods: Retrospective analysis of 5 cases of phosphide containing rodenticide poisoning admitted to St. John's Medical College Hospital during the period of 2015-2017. Results: All 5 patients were females with a median age of 25 years (range 24-31). No one had past history of alcohol consumption, chronic liver disease or other co-morbidities. All 5 patients were nursed in Intensive care unit. During the course of stay, all patients had deranged liver function test and coagulation profile. Complications noted during the period were acute kidney injury (80%, n=4) of which three required hemodialysis, worsening metabolic acidosis (60%, n=3) and adult respiratory distress syndrome (40%, n=2) requiring mechanical ventilation. Two patients (40%) recovered with conservative management (N-acetyl cysteine) and three patients (60%) succumbed to their illness in ICU. Average length of stay was 11.2 days(5-21). Conclusions: Acute liver failure due to DILI often affects young individuals and has a high risk of morbidity and mortality. As there is no effective antidote for phosphide poisoning, Liver transplantation at the earliest often remains the only life saving therapy. Regularly used criterias for transplantation doesnot address phosphide poisoning and hence a scoring model for the same is warranted.

Psychosis and Rodenticides: A Case Report

: Objective: A poison can be any substance that can be taken through any means with net production of toxicity, which may result into death and coma as well. The evolution of rodenticides through history, witnesses the large-scale use of the first and the second-generation rodenticides those are commonly found with many of the household items meant for pest control. Psychosis is a mental health issue associated with episodes of hallucinations and delusions. This leads to the patient’s misinterpretation of the surrounding environment. Few literatures have been reported regarding the use of rodenticides in psychotic patients. Manifestations of rodenticide poisoning includes gastric irritations, flank pain, gastric distension etc. The management focus of rodenticide poisoning should be more prominently based on most recent updated guidelines and dose titration should be monitored on the laboratory outcomes. Monitoring is the key to remission.Key words: Adverse Drug Reactions, Psychosis, Poison, Rodenticides, Self-Harm.

Retrospective Study of the Characteristics of Anticoagulant-Type Rodenticide Poisoning in Hong Kong

Warfarin- and superwarfarin-type anticoagulants are commonly used as rodenticides. Exposure to these agents, especially superwarfarins with long-acting anticoagulant effect, can cause life-threatening coagulopathy in humans. Most superwarfarin poisoning cases had an obvious history of exposure, though occult cases without exposure history have also been reported. The current study aims to examine anticoagulant-type rodenticide poisoning in Hong Kong and to identify the similarities and differences between patients with known exposure history and those whose exposure is recognized only through laboratory testing. The present study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. This was a retrospective cohort study of all patients with biochemically confirmed anticoagulant-type rodenticide exposure, from 2010 to 2014. Superwarfarin was the most common group of anticoagulant-type rodenticides identified (87.8%), in which bromadiolone and brodifacoum were the most frequently encountered. Among the 41 cases identified, 31 had an obvious exposure history, and 10 were occult poisoning in which the context of exposure remained unidentified. All occult poisoning patients without exposure history presented with bleeding events. These occult poisoning cases often went unrecognized by frontline clinicians, leading to delayed investigation and initiation of treatment. This group of patients was associated with a longer time to diagnose coagulopathy (p < 0.001) and confirm rodenticide poisoning (p < 0.05), a higher rate of international normalized ratio (INR) rebound after initiation of antidote (p < 0.001), and a longer time needed for normalizing INR (p < 0.05). Occult superwarfarin poisoning is an important yet under-recognized differential cause of unexplained coagulopathy. A high index of clinical suspicion and availability of specialized toxicological test for superwarfarins play a vital role in diagnosis and early initiation of appropriate management. The underlying cause of such poisoning remains obscure and warrants further study.

Anticoagulant rodenticide poisoning

Abstract Anticoagulant rodenticides are one of the common household pesticides which may be consumed intentionally or unintentionally by human subjects. The diagnosis of poisoning may be missed without a suggested history. The bleeding episodes may be delayed by days to weeks after an exposure to anticoagulant rodenticides. The second generation rodenticides (LAARs) may lead to ‘rebound coagulopathy’ which is highly suggestive of a possible diagnosis of poisoning. The definitive diagnosis of rodenticide poisoning may be made by utilizing HPLC to determine serum levels of specific anticoagulant levels. Patients are triaged and observed along with periodic assessment of coagulopathy. Bleeding patients require acute interventions followed by long term administration of vitamin K1 to manage rebound coagulopathy.

A California without Rodenticides: Challenges for Commensal Rodent Management in the Future

Author(s): Quinn, Niamh; Kenmuir, Sylvia; Krueger, Laura | Abstract: Rodenticides are an essential tool in the integrated pest management (IPM) of infestations of commensal rodents. With the introduction of Assembly Bill 2422 California Natural Predator Protection Act, the State of California is potentially facing a future with serious restrictions on the use of anticoagulant rodenticides to manage commensal rodents in urban areas. Assembly Bill 2422 has been proposed to protect predators from rodenticide poisoning and seeks to significantly restrict the application of first and second generation anticoagulant rodenticides for use in many urban and no-urban areas of California. Exclusion and cultural practices, such as landscape management and sanitation, are important and successful tools for managing rodent populations. However, quick and efficient control of commensal rodent infestations often necessitates the use of rodenticides. While rodenticide is an important tool, exposure of wildlife to anticoagulant rodenticides has been evident for many years in the state of California. When rodents are consumed by predators, second generation anticoagulant rodenticides can be detected as residues in the livers of predators. Many species of animals are documented as having succumbed to rodenticide toxicosis, however the effects of chronic, sub-lethal exposure to predators are not well understood. This paper will discuss the current and proposed changes to rodenticide legislation in California, impacts of the legislation on communities across California, and gaps in research preventing the adoption of evidence-based best management strategies for rodent control. In order to improve the success of commensal rodent control programs in California, effective strategies for rodent management must be developed.

Rat Killer Poisoning vs Liver Damage: A View in South Indian Patients of Tertiary Care Center

Background: Rodenticide ingestion is common suicidal poisoning. In the absence of antidote, consumption is fatal. We aimed at socio-demographic characteristics, analyzed predictive factors, biological elevation curve and its outcome. Methods: 101 patients admitted with rodenticide poisoning. Socio-demographic characteristics, probable predictive factors, Serial charting biological markers recorded. Standard care management was given. Results: Of the 101 patients 76% were from rural and 24% urban. 62% were female and male 38%. Mean age was 26.0 ± 10.467 years. Unmarried men and married women were higher. Higher number was literate 46% and Illiterate 28%. Higher number was salaried 45% and students 30%. 34% consumed raw, 30% mixed with water. 57% ingested 20 grams. Mean dosage of 13.42 ± 7.069 grams. Mean care seeking time 6.0 ± 6.3702 hours. 46% sought 10 hours. Chief symptom was vomiting in 33% patients, abdominal pain 36%, headache 27% and oral bleeding 4%. Biological markers in survivor and non-survivor showed, T bill, Albumin, AST, ALT, Creatinine, PT, INR and MELD were statistically significant. T protein, platelet and urea were not significant. 9 patients had MELD 30 MELD was in 27. All of those had a MELD of >40 died. 41% had toxic hepatitis, 21% acute liver failure, 19% toxic hepatitis with acute kidney injury/ALF with acute kidney injury and 19% developed multiple organ failure. Overall mortality rate was 19%, 81% recovered with 8.88 days mean hospital stay. Conclusions: Patient ingested yellow phosphorus had liver damage. Lethal dosage and late presentation to medical facility led to liver failure, multiple organ failure and mortality in spite of standard care. Creating awareness, promoting mental health, suicide prevention and framing proper guidelines of treatment are best cornerstones to reduce mortality by rat killer poisoning.