Highly Toxic Signal Word: DANGERb (LD50< 50 mg/kg) | | | | | |
Thallium | White, crystalline, odorless, tasteless | Combines with mitochondrial sulfhydryl groups, interferes with oxidative phosphorylation | 14 mg/kg | Anorexia, abdominal pain, diarrhea, painful neuropathy, delirium, coma, seizures, alopecia (late), Mees lines | GI symptoms acutely, other symptoms 12–14 hours delay | Activated charcoal, Prussian blue |
Sodium monofluoroacetate (SMFA, compound 1080) | White, crystalline, odorless, tasteless, water soluble | Fluoroacetate to fluorocitrate; interferes with tricarboxylic acid cycle | 3–7 mg/kg | Seizures, coma, tachycardia, PVCs, VT, VF, ST-T wave changes, rhabdomyolysis (hypocalcemia) | 1/2–20 hours | Experimental regimens (Chap. 115) |
Sodium fluoroacetamide(compound 1081) | Same as SMFA | Same as SMFA; fluoride toxicity | 13–14 mg/kg | Same as SMFA | Same as SMFA | Same as SMFA |
Strychnine | Bitter taste | Glycine receptor antagonist on spinal cord motor neurons | Children: 15 mg Adults: 1–2 mg/kg | Restlessness, anxiety, twitching, hyperextension alternating with relaxation, intense pain, trismus or facial grimacing (“risus sardonicus”), inability to swallow, opisthotonos | 10–20 minutes | Quiet room, IV, benzodiazepines, neuromuscular blockade |
Zinc phosphide | Heavy, gray, crystalline powder, water insoluble, “rotten fish” or “phosphorus” odor; normally used as 1% concentration | Releases phosphine on contact with water or acid or in Gl tract | 40 mg/kg in rats | “Rotten fish” breath odor, black vomitus, Gl and cardiovascular toxicity, acute respiratory distress syndrome, agitation, coma, seizures, hepatic and renal toxicity | Within hours; inhalation may have delayed onset | Dilution with sodium bicarbonate water or milk |
Elemental phosphorus (yellow or white phosphorus) | Yellow, waxy paste, fat soluble, water insoluble | Local irritation and burns on contact followed by Gl, liver, and kidney damage, and interferes with clotting | 1 mg/kg (more toxic if dissolved in alcohol, fats, oils) | Skin and Gl burns, “smoking” luminescent vomitus and stools with garlic odor, jaundice, dysrhythmias, coma, delirium, seizures, cardiac arrest | 1–2 hours | Supportive care |
Arsenic trioxide | White, crystalline powder | Combines with sulfhydryl groups and interferes with a variety of enzymatic reactions | 1–4 mg/kg | Dysphagia, nausea and vomiting, bloody diarrhea, cardiovascular collapse, (VT, torsade de pointes) garlic odor, altered mental status, late sensory/motor neuropathy | Symptoms: 1 hour Death: 1–24 hours | Succimer, dimercaprol until urine arsenic concentration < 50 μg/L Hemodialysis to remove chelation compound if acute kidney injury develops. |
Barium (soluble forms: carbonate, chloride, hydroxide) | Yellow, white, slightly lustrous lump | Hypokalemia, neuromuscular blockade | 20–30 mg/kg | Headache, paresthesias, muscle weakness, paralysis, nausea, vomiting, diarrhea, abdominal pain, prolonged QT interval, dysrhythmias, cardiac and pulmonary failure | 1–8 hours | Orogastric lavage with Na2SO4, or another sulfate salt (magnesium), potassium replacement |
PNU (N -3-pyridylmethyl- N’- p-nitrophenyl urea, Vacor) | Yellow, resembling cornmeal or yellow green powder in bait; odor: peanuts | Interferes with nicotinamide metabolism in pancreas(destroying pancreatic β cells), central and peripheral nervous system, and heart | 5 mg/kg | Nausea and vomiting, abdominal pain, severe orthostatic hypotension, hyperglycemia with or without ketoacidosis, gastrointestinal perforation, pneumonia, neuropathy | 4–48 hours | Nicotinamide (niacinamide) 500 mg IV or IM (historically used, but likely unavailable), manage diabetic ketoacidosis |
Tetramine (tetramethylene disulfotetramine, TETS, TEM) | White powder | Noncompetitive, GABA antagonism by direct blockade of chloride ionophore | 5–10 mg/kg | Refractory status epilepticus, fainting, coma, coronary ischemia | 0.5–13 hours | Benzodiazepines, barbiturates, propofol, neuromuscular blockers |
Moderately Toxic Signal Word: WARNINGa (LD50, 50–500 mg/kg) |
α-Naphthylthiourea (ANTU) | Odorless, slightly bitter, fine, blue-gray powder, water-insoluble | Acute respiratory distress syndrome | > 4 g/kg | Hypothermia, dyspnea, crackles, clear pulmonary froth, cyanosis | ? | Supportive care |
Cholecalciferol (vitamin D3) | 0.075% pellets, 364 pellets/oz;(1 pellet = 2308 U vitamin D) | Hypercalcemia | ? | Headache, lethargy, weakness, fatigue, polyuria, acute kidney injury and failure, hypertension, hypercalcemia | Hours to days | Fluids; if severe: furosemide, prednisone, calcitonin, bisphosphonates hemodialysis |
Low Toxicity Signal Word: CAUTIONa (LD50, 500–5000 mg/kg) | | | | | |
Red squill | Bitter taste | Cardioactive steroid poisoning | ? | Myocardial irritability, blurred vision, hyperkalemia | 30 minutes–6 hours | Digoxin-specific Fab, atropine |
Norbormide (dicarboximide) | Yellow cornmeal bait, peanut butter, 1% concentration | Vasoconstriction and ischemia in rats only via specific norbormide receptor in rat smooth muscle | Unknown, toxicity at < 300 mg | Transient hypothermia and hypotension | ? | Supportive care |
Bromethalin | 7.5% concentrate, green pellets, with Bitrex (denatonium benzoate) | Uncouples oxidative phosphorylation; interrupts nerve impulse conduction | ? | Muscle tremors, myoclonic jerks, flexion of major muscles, coma?, ataxia, focal motor seizures | Immediate | Supportive care |
Anticogulants: Short-Acting |
Warfarin | Yellow cornmeal, rolled oats (0.025%) | Anticoagulation via interference with clotting factors II, VII, IX, X | >5–20 mg/day for > 5 days | Elevated INR; bleeding death from hemorrhage | 12–48 hours  | Vitamin K1, fresh frozen plasma as indicated, prothrombin complex concentrate |
Prolin | Warfarin (0.025%) plus sulfaquinoxalin (0.025%) | Anticoagulant antibiotic combination eliminates intestinal vitamin K producing organisms | NA | Elevated INR; bleeding, death from hemorrhage | | |
Anticoagulants: Long-Acting | | | | | | |
Hydroxycoumarins | | | | | | |
4-Hydroxycoumarin (brodifacoum, difenacoum) Warfacide (coumafuryl) | 0.005% grain-based bait  0.5% for dilution to 0.025% white powder, tasteless, odorless | Anticoagulation via interference with clotting factors II, VII, IX, X  | | Elevated INR; bleeding, death from uncertain hemorrhage  | Delayed several days  | Vitamin K, fresh frozen plasma as indicated Prothrombin complex concentrate |
Indandiones | | | | | | |
Pindone (Pival) Pivalyn Diphacinone Chlorophacinone Valone | Moldy, acrid odor, fluffy yellow powder, concentrations 0.005–2.5%  0.5% 0.005–2.0% 0.005–2.5% 0.005–2.5% | Anticoagulation via interference with clotting factors II, VII, IX, X  | | Chronic ingestion possibly produces cardiac and neurologic symptoms, elevated INR; bleeding, death from uncertain hemorrhage  | Delayed several days  | Vitamin K, fresh frozen plasma as indicated Prothrombin 1 complex concentrate |