Rodenticide and Chemical Poisoning Management

Initial Assessment and Treatment

For patients with signs of shock or respiratory distress, evaluate for signs of bleeding and check vital signs for hemodynamic stability, as recommended by the American Heart Association, with a strength of evidence level of expert opinion 1
Ensure airway patency, monitor for respiratory distress, and assess hemodynamic status for signs of shock 2, 3
In case of chemical ingestion, immediately contact poison control and activate emergency medical services if the patient shows life-threatening symptoms such as sleepiness, seizures, difficulty breathing, or vomiting 2, 3

For other types of rodenticides, such as bromethalin, cholecalciferol, and strychnine, treatment is supportive and specific to the toxin, and clinicians should consult poison control for specific management guidelines, as recommended by the American Heart Association, with a strength of evidence level of expert opinion 1
Antimicrobial drugs are contraindicated for routine treatment of uncomplicated, watery diarrhea, but specific indications for antimicrobials include cholera, Shigella dysentery, amoebic dysentery, and acute giardiasis, as recommended by the CDC 4
Anti-diarrheal agents, stimulants, steroids, and purgatives are contraindicated and may produce adverse effects 4

For skin exposure to powdered chemicals, brush off with gloved hand or cloth before irrigation, and for certain dry chemicals (e.g. sodium hydroxide, elemental sodium, potassium), perform dry decontamination first to avoid thermal injury 3
Certain chemicals (e.g. hydrofluoric acid, phenol) require specific decontamination agents, and chemical-specific treatment recommendations should be followed from Safety Data Sheets or poison centers 3
Provide supportive care, including monitoring for continued symptoms or signs of significant injury, and follow poison control recommendations for duration of observation and follow-up, with a minimum observation period of 4-6 hours for hydrogen peroxide ingestion 2, 3, 5

Monitor vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, and watch for signs of stridor, respiratory distress, or oral burns 2
Conduct laboratory tests, including complete blood count, electrolytes, and renal function, to assess for complications, and consider coagulation profile if significant bleeding is present 2
Advise patients to seek medical attention if symptoms persist or worsen, unable to maintain adequate hydration, passing many stools, extreme thirst, sunken eyes, fever, or general deterioration 4

Emphasize handwashing with soap, promote general domestic and personal hygiene, teach safe food-handling practices, ensure proper food storage and preparation temperatures, and avoid cross-contamination between raw and cooked foods 4
The American Heart Association recommends calling Poison Control Center immediately and providing specific information, including nature and time of exposure, name of chemical/product, approximate amount ingested, current symptoms, and patient age and weight 2, 5