European Journal of Cardiovascular Medicine

Rat poisoning, often known as rodenticide poisoning, is still the second most prevalent swallowed poison in our area, behind organophosphorus poisoning. The easy access to rodenticides in homes is a major factor in consumption.¹ Due to its extreme danger and widespread ignorance of its deadly effects, there is a significant death rate from it. These are produced by businesses that package and sell them with warning signs and information about the contents in case humans are unintentionally exposed to them. However, they are also produced locally without any knowledge of the contents.²

Nonetheless, the literature on rodenticide poisoning is much less extensive than that on organophosphorus poisoning. ³ Almost every home has access to rodenticides in order to protect their stored grains against rodents, who are present everywhere. Because it is more affordable and readily accessible than other insecticides on the market. Due of its widespread availability, it is frequently taken with suicidal intent or inadvertently consumed by minors.⁴

Phosphorus is the most prevalent and deadly poison among these rodenticides, especially when liver damage starts to occur three to four days after ingestion. With consequences such as acute renal injury, hepatic encephalopathy, bleeding manifestations brought on by coagulopathy, acute respiratory distress syndrome, and acute liver failure, among others, toxicity can range from asymptomatic individuals to fatality.⁵ Present study was aimed to study clinical features and outcome of rodenticide (ratkill) poisoning.

Present study was prospective, observational study, conducted in department of General Medicine, at Vilasrao Deshmukh Government Medical College and Hospital, India. Study duration was of 18 months (from August 2022 to Feb 2024). Study was approved by institutional ethical committee.

Inclusion criteria

• Age of patient above 18years, admitted with rodenticide poisoning, willing to participate in present study

Exclusion criteria

• Unwilling patients.
• Patients not fulfilling inclusion criteria
• Mixed poisons
• Chronic liver disease
• Alcohol intake within 24hours before admission
• Patients on drugs like anti-coagulants and anti-platelets
• Patients with bleeding disorders

Study was explained to participants in local language & written informed consent was taken. The risks and benefits involved in the study and voluntary nature of participation were explained to the participants before obtaining consent. Confidentiality of the study participants was maintained.

The patients data was collected after taking approval from ethical committee. Patients data was collected such as gender, age, nationality etc. current study was done among patients with age above 18years who were present with history or signs of rodenticide poisoning during the study period. The data and information pertaining to the cases were collected and recorded on a proforma. Wherever possible the attendents of the patients were asked to get the packaged or the package insert of the poison to confirm the history and examination findings. A complete hemogram, renal function tests, prothrombin time, and ECG were done for all patients. Other investigations such as arterial blood gas analysis, echocardiogram were left to the discretion of the treating physician and hence were not performed for all the patients. The clinical profile was recorded according to the poisoning severity score grading.

Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Data was also represented using appropriate diagrams like bar diagram, pie diagram and box plots. Statistical analysis was made with IBM SPSS 16.0 software and P value of <0.05 was considered significant.

In present study, among 115 patients, majority of patients belong to age group of 21 to 30 years (50.4%) followed by age group of 11 to 20years (27.8%). Mean age of patients was 26.48 ± 9.48 years. 49.6% of patients were males whereas 50.4% of patients were males where female predominance was observed. 62.6% of patients were married whereas 37.4% of patients were unmarried.

Table 1: General characteristics

In current study, 65.2% of patients had rodenticide in form of powder, 23.5% of patients had rodenticide in form of bait and 11.3% of patients had rodenticide in form of paste. In current study, 96.5% of patients consumed rodenticide for suicide whereas 3.5% of patients consumed rodenticide accidentally. Duration to reach medical care in majority of patients (59.1%) was 24 to 72hours followed by 13.9% of patients was 6 to 12hours, 13% of patients was 12 to 24hours, 8.7% of patients was more than 72hours and 5.2% of patients was 0 to 6hours. 75.7% of patients consumed rodenticide of less than 30grams, 20% of patients consumed rodenticide of 31 to 60grams and 4.3% of patients consumed rodenticide of more than 61grams with mean amount of 22.17 ± 19.47grams.

Figure 1

Figure 2

Figure 3

Table 2: Rodenticide characteristics

In current study, majority of patients had vomiting (60.9%) followed by hematemesis and melena (each 27.8 %), abdominal pain (12.2 %), chest pain and breathlessness (each 9.6 %), fever and hematuria (each 8.7 %) & bleeding gums and seizures (each 7.8 %).

Figure 4

Figure 5

Figure 6

Table 3: Distribution of patients according to clinical features: (n=115)

In current study, the mean hemoglobin in the patients was 12.81 ± 2.3g/dl with a range of 5 to 14.5g/dl. The mean total count in the patients was 7050.82 ± 5245.07per mm3 with a range of 1100 to 12000per mm3. The mean platelet count in the patients was 158114.86 ± 123450.99per liter with range of 20000 to 300000 per liter. In current study the mean urea in the patients was 30.81 ± 20.63 with a range of 20 to 150. The mean creatinine in the patients was 1.07 ± 0.81 with a range of 0.7 to 5.5. In current study, the mean sodium in the patients was 138.46 ± 6.74 with a range of 100 to 155. The mean potassium in the patients was 3.76 ± 0.38 with a range of 2 to 4.4. The mean calcium in the patients was 10.71 ± 1.07 with a range of 9.5 to 17.

In current study, the mean bilirubin in the patients was 1.26 ± 1.04 with a range of 0.9 to 6.00. The mean SGOT in the patients was 30.13 ± 22.07 with a range of 15 to 120. The mean SGPT in the patients was 29.96 ± 21.74 with a range of 15 to 120. In current study, the mean bleeding time was 5.45 ± 5.01 with a range of 2 to 20. The mean clotting time was 6.5 ± 2.82 with a range of 4 to 15. The mean pro- thrombin time was 17.96 ± 12.95 with a range of 10 to 50. The mean INR was 1.7 ± 1.4 with a range of 0.8 to 5.

Figure 7

Table 4: Distribution of patients according to clinical features: (n=115)

In current study, 27.8% of patients had occult blood in stool, 6.9% of patients had arrthymias & 4.3% of patients showed lung infiltration. 93.9% of patients had normal USG abdomen, 3.5% of patients had fatty liver and 2.6% of patients had cholecystitis. In current study, in X-ray chest whereas 95.7% of patients had normal chest x-ray findings. 15 patients underwent CT brain. 20% of patients who underwent CT showed intra-cranial haemorrhage.

Table 5: Other characteristics

In current study, the mortality rate among the study participants was 7% whereas 93% of patients survived.

Table 6: Distribution of patients according to outcome

significant global public health concern, poisoning is becoming more common as a result of societal and lifestyle changes. The World Health Organization (WHO) reports that 6.3 million years of healthy life (disability adjusted life years, or DALYs) and 106,683 deaths worldwide were caused by unintentional poisoning.^7,8

Lethal rodenticide poisoning results in severe symptoms affecting multiple vital organs. These are some of the most hazardous materials that are frequently discovered in houses. Numerous types of rodenticides have been employed over the years.70 India is a country primarily made up of villages, where most of the population works in agriculture and farming. Among the many pests that harm crops and grains that are stored are rodents. An unchecked rodent infestation will cost farmers a great deal of money. Therefore, rodent control is required, requiring widespread marketing and use of rodenticides in India.⁹

In a study done by Naidu MA et al.,¹⁰ showed that majority of patients belong to age group of 21 to 40years (48.3%) which was slightly similar to present study findings. Similarly in a study done by Tassew SF et al.,¹¹ showed that majority of patients (54.5%) belong to age group of 20 to 40years. Also in a study done by Murugesan et al.,¹² showed that majority of patients belong to age group of 21 to 30years with 35% of patients.

In current study, 49.6% of patients were males whereas 50.4% of patients were females where female predominance was observed. In a study done by Naidu MA et al.,¹⁰ showed that 56.9% of patients were females and 43.1% of patients were males. In a study done by Tassew SF et al.,¹¹ showed that 53.2% of patients were females and 46.8% of patients were males. In a study done by Murugesan et al.,¹² showed that 59% of patients were females and 41% of patients were males. In a study done by Rajashekar S et al.,¹³ showed that 61.1% of patients were females and 38.9% of patients were males with male predominance which was similar to present study findings.

In current study, 62.6% of patients were married whereas 37.4% of patients were unmarried. In a study done by Naidu MA et al.,¹⁰ showed that 55.2% of patients were married and 37.8% of patients were unmarried. In a study done by Tassew SF et al.,¹¹ showed that 51.3% of patients were married and 48.7% of patients were unmarried. In a study done by Murugesan et al.,¹² showed that 58% of patients were married and 42% of patients were unmarried where all the studies showed similar to present study findings where there was higher number of married patients.

In current study, 65.2% of patients had rodenticide in form of powder, 23.5% of patients had rodenticide in form of bait and 11.3% of patients had rodenticide in form of paste. In current study, 96.5% of patients consumed rodenticide for suicide whereas 3.5% of patients consumed rodenticide accidentally. In a study done by Naidu MA et al.,¹⁰ showed that suicidal consumption was in 89.7% of patients and accidental in 10.3% of patients. In a study done by Tassew SF et al.,¹¹ showed that 80.1% of patients had suicidal consumption and accidental in 19.9% of patients. In a study done by Rajashekar S et al.,¹² showed that suicidal consumption was observed in 94.4% of patients and accidental in 5.6% of patients.

In current study, the duration to reach medical care in majority of patients (59.1%) was 24 to 72hours followed by 13.9% of patients was 6 to 12hours, 13% of patients was 12 to 24hours, 8.7% of patients was more than 72hours and 5.2% of patients was 0 to 6hours.

In a study done by Naidu MA et al.,¹⁰ showed that majority of patients (62.1%) arrived medical care within 2hours of ingestion. In a study done by Tassew SF et al.,¹¹ showed that majority of patients reached medical attention within 2hours of ingestion (57.7%). In a study done by Murugesan et al.,¹² showed that more than half of the patients (58%) reached medical care within 6hours of ingestion. In a study done by Balasubramanian K et al.,¹⁴ showed majority of patients (36.7%) arrived medical care within 1 to 3hours of ingestion.

In current study, majority of patients had vomiting (60.9%) followed by hematemesis and melena (each 27.8 %), abdominal pain (12.2 %), chest pain and breathlessness (each 9.6 %), fever and hematuria (each 8.7 %) & bleeding gums and seizures (each 7.8 %). 93.9% of patients had normal USG abdomen, 3.5% of patients had fatty liver and 2.6% of patients had cholecystitis. In X-ray chest 4.3% of patients showed lung infiltration. 15 patients underwent CT brain. 20% of patients who underwent CT showed intra-cranial haemorrhage.

In a study done by Naidu MA et al.,¹⁰ showed that 94.8% of patients had symptoms related to GIT such as abdominal pain and vomiting, 27.6% of patients had tachycardia and 15.5% of patients had tachypnea. In a study done by Tassew SF et al.,¹¹ showed that 94.9% of patients had GI tract symptoms such as abdominal pain vomiting, 31.4% of patients had tachycardia and 15.4% of patients had tachypnea. In a study done by Rajashekar S et al.,¹² showed that 62.7% of patients had vomiting and nausea, 52.4% of patients had abdominal pain, 30.2% had headache, 19.8% had giddiness, 11.1% had chest pain with palpitations and 8.7% had bleeding. In a study done by Balasubramanian K et al.,¹⁴ showed that 36.7% of patients had nausea & vomiting, 20% had giddiness, 20% had giddiness, 16.7% had abdominal pain, 8.33% had chest pain with palpitations and 0.8% had seizures.

In current study, the mortality rate among the study participants was 7% whereas 93% of patients survived. Varied mortality rate was noted in different studies as Naidu MA et al.,¹⁰ (3.4 %), Tassew SF et al.,¹¹ (49.6 %), Murugesan et al.,¹² (37 %), Rajashekar S et al.,¹³ (6.3 %), Patil S et al.,¹⁵ (10 %) & Shashidara KC et al.,¹⁶ (20.3 %).

As a whole, rodenticide poisoning did not turn out well. Poor rodenticide poisoning outcomes included tachycardia, suicidal poisoning, and referral from another health center. It is advised that healthcare professionals reorganize in order to produce data regarding the fatality rate of rodenticide poisoning and suicidal behavior. It is imperative for healthcare personnel and organizations to provide counseling and family-centered services that enable adults to build coping mechanisms. Additionally, patients who have been exposed to rodenticides should receive extra attention to their vital signs.

Compared to other pesticides, rodenticide poisoning is more prevalent manageable, and typically suicidal in nature. It is also more readily accessible and less expensive. Human mortality rates from rodenticide poisoning vary, so prompt detection and prompt therapy are crucial for successful treatment. A few risk factors include being too aged or young, reaching at the hospital too late, and ingesting too much of the poison. Liver parameters are useful in managing the illness and are essential in tracking the prognosis of the disorder. In order to lower the frequency of suicide, it is necessary to implement suicide prevention techniques such as counseling and mental health support in accordance with the national mental health program.

Conflict of Interest: None to declare

Source of funding: Nil

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