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Learning Objectives:
Define the nature of rodenticides
Identify the major classes of rodenticides
Recognize the pathophysiology of some rodenticides
Describe signs and symptoms of their toxicity
Assess severity of poisoning by different methods of investigations
Treat rodenticide poisoning and specify antidotes
Use of rodenticides : to kill rodents and insects
Types: anticoagulant and non-anticoagulant.
Anticoagulant rodenticides
Hydroxy C. 4-H.C.
e.g warfarin
Regular warfarins: Super warfarins:
Massive or repeated doses Single, small dose
1) , 2) bleeding tendencies
Clinical picture
Investigations
Identify the type (box)
P.T, INR
Monitoring of P.T in long acting (super warfarins)
CBC, blood grouping
Vit K-dependent factors
Rodenticide screening (RIA, HPLC, GC-MS)
Treatment
1-A.B.C.
2-Decontamination:
super warfarins.
4-Vit K1 :
They are more serious and may cause death as a result of single
ingestion. They are divided into three groups according to toxicity.
Highly toxic:
Arsenic, phosphorus, strychnine, thallium, and zinc phosphide.
Moderately toxic:
ANTU (α- naphthyl thiourea)
Low toxic:
Norbormide and red squill.
Zinc phosphide
Pathophysiology:
Zinc phosphide reacts with water and hydrochloric
acid in the stomach producing phosphine gas which
causes systemic toxicity.
Clinical picture:
GIT: Nausea, vomiting, abdominal pain ,
diarrhea, black in color.
Respiratory: Rotten fish odor of breath, chest
tightness, cough, dyspnea, crepitations,
pulmonary edema and subpleural
hemorrhage.
CVS: Hypotension, shock, arrhythmia
CNS: Ataxia, seizures,coma.
Hepatorenal toxicity
Others: Hypocalcemia, tetany, renal failure.
Treatment:
1. A-B-C
2. Dilution with milk or starch then gastric lavage with
sodium bicarbonate to alkalinize the gastric
environment and decrease the conversion of phosphide
to phosphine.
3. Activated charcoal decreases absorption of phosphide.
4. Symptomatic treatment:
Diazepam for seizures
Ca gluconate or chloride I.V for tetany.
5. Ca Na2 EDTA: may have a role.
STRYCHNINE
It is a very bitter crystalline powder obtained by
crushing strychnous nux vomica seed.
The active principles are mainly strychnine and
brucine, but strychnine is 20 times more potent.
Uses
Suicidal:
By pharmacists, medical personnel and agricultural workers.
Homicidal:
Is very rare due to its bitter taste and rapid action. Sporadic
cases do occur by giving the poison with alcohol or foods
which normally have a sour taste.
Pathophysiology:
It is a convulsing poison. Convulsions result from either:
Blocking of Enhancing of
inhibition. excitation.
Contraction of the
muscle of the jaw
(locked jaw).
The abdominal and respiratory muscles are
involved in the generalized convulsions with
Cyanosis Consciousness is
Lactic acidosis
Rhabdomyolysis
Hyperthermia
Diagnosis:
1.Circumstantial evidence
2.History of:
Sudden appearance of the paroxysm in a healthy person.
Negative history for any injury or disease and the attack is
directly related to the intake of medicine or ingestion of food or
drink.
3.Clinical diagnosis: occurrence of sudden, phasic, painful, diffuse,
symmetric, extensor thrust.
4.Laboratory diagnosis: by thin layer chromatography , even after
death as it resists putrefaction
Differential diagnosis:
From other causes of convulsions:
Traumatic.
Pathological (meningitis, epilepsy).
Toxic e.g. organophosphorous and carbamate insecticides,
carbolic acid, oxalic acid poisoning ... etc.
The most important D.D. is from tetanus by:
TETANUS STRYCHNINE
Injury Intake of drug • History
Gradual Sudden • Onset
Start in the jaw Generalized from the start • Convulsions
Absent as the convulsions are tonic Present and complete • Pause between attacks or
and the muscles remain rigid (relaxation)
Death within few days Fatal within ½ - 2 hours • Prognosis
-ve Strychnine • Chemical analysis
Tetanic bacilli -ve • Bacterial analysis
Treatment:
Strychnine antagonists
control convulsions and prevent asphyxia by
Diazepam Phenobarbital
Muscle
5 - 10 mg IV 5 mg/kg IV
relaxant
of Phenobarbital preceded by
ventilation.
Prevent recurrence of convulsions
Decrease absorption