Rodenticides, often termed as rat poisons, have been utilized extensively across the globe for controlling rodent populations, particularly in agrarian societies and urban environments.(1) India, predominantly an agricultural nation, sees a considerable use of these chemical agents in both rural and urban settings.(2) While the main intent behind their use is rodent population control, the inadvertent or intentional ingestion by humans has presented substantial clinical challenges. In recent years, the prevalence, clinical profile, complications, and outcomes of rodenticide poisoning have emerged as crucial subjects of study in the medical community, especially within the context of tertiary care hospitals.

 The prevalence of rodenticide poisoning in India has shown alarming figures. Multiple factors contribute to these high prevalence rates. For one, the easy availability and affordability of these chemicals in the Indian market make them accessible to the general population.(3) Additionally, the lack of stringent regulations concerning their sale and distribution further exacerbates the issue.(4) In this scenario, tertiary care hospitals often become the front line in addressing and managing these poisoning cases.

Clinically, the presentation of rodenticide poisoning can range from mild gastrointestinal symptoms to severe multi-organ dysfunction, depending on the type of rodenticide and the amount ingested.(5) The vast range of rodenticides available in the market, each with its distinct chemical profile and toxicological properties, further complicates the clinical picture.(6) Recognizing the specific clinical manifestations becomes imperative for appropriate management and to mitigate long-term complications.

 The complications of rodenticide poisoning are multifaceted. Anticoagulant rodenticides, for instance, can cause spontaneous bleeding and are associated with a risk of life-threatening hemorrhage.(7) On the other hand, non-anticoagulant rodenticides can affect various organ systems, leading to symptoms like acute renal failure, neurotoxicity, and cardiotoxicity. Given the varied clinical presentations and potential complications, timely diagnosis and intervention become paramount.

As with any poisoning, the outcome of rodenticide ingestion largely depends on the type of agent, dose, time elapsed since ingestion, and the promptness and effectiveness of medical interventions. Research from tertiary care hospitals across India has indicated a spectrum of outcomes, from complete recovery to fatality. Understanding these outcomes and their determinants is essential for clinicians to predict, manage, and possibly prevent the adverse effects of such poisonings.

AIMS AND OBJECTIVES OF THE STUDY

1. To evaluate the incidence of rodenticide poisoning in tertiary care hospital
2. To evaluate the clinical profile of rodenticide poisoning

Source of data –All patients who report to the department of casualty with alleged rodenticide consumption.

 Study type- Hospital based prospective study

Sampling type- Period sampling

Study period- Period of 1 year

Estimation of sample size: According to the Study by Abhilash KP (2022), prevalence of rodenticide poisoning accounts for 8% of all poisoning.9

The sample size (n) is calculated according to the formula: n = z2 * p * (1 - p) / e2

Where: z = 1.96 for a confidence level (α) of 95%, p = proportion (expressed as a decimal=0.08), e = margin of error.

 z = 1.645, p = 0.08, e = 0.05

 n = 1.6452 * 0.08 * (1 - 0.08) / 0.052

 n = 0.1992 / 0.0025 = 79.665 n ≈ 80

Based on the sample size calculation, it was decided to enroll 100 subjects, to account for any probable dropouts or withdrawal from the study.

Inclusion criteria

1. Patients of any gender aged 18 years and above.
2. Patients who have ingested rodenticides, namely: Zinc Phosphide, Bromodialone, Brodifacoum, or Yellow Phosphorus.
3. Patients presenting within 48 hours of suspected rodenticide ingestion.
4. Patients willing to provide consent for the study (or have a guardian/next-ofkin provide consent if they are incapacitated).
5. Patients who have clear clinical or circumstantial evidence of rodenticide ingestion (like presence of the rodenticide container, witness account, or selfreport).

Exclusion criteria

1. Patients below the age of 18 years.
2. Patients with a history of chronic rodenticide exposure (e.g., occupational exposure) rather than acute ingestion.
3. Patients presenting after 48 hours of suspected rodenticide ingestion.
4. Patients with co-ingestion of other toxic substances or medications that might confound the study results.
5. Patients with pre-existing medical conditions that might mimic the symptoms of rodenticide poisoning, such as chronic liver disease, chronic kidney disease, or coagulation disorders.
6. Patients unwilling or unable to provide informed consent for participation in the study.
7. Patients who are pregnant or breastfeeding

METHODOLOGY:

Informed written consent was taken from the patient when possible, and from the patient's attenders after explaining the aims and objectives of the study. They were educated regarding the disease's prognosis and progression. Socio-demographic data, such as age, gender, marital status, and occupation were noted. Information including time of ingestion, nature, amount, type, and route of exposure to the rodenticide was also recorded. Whenever feasible, the patient's attenders were requested to bring the poison package or the package insert to confirm history and examination findings. A detailed examination was then conducted for signs of renal failure and hepatic failure such as bilateral lower limb edema, pulmonary edema, right hypochondrial tenderness, hepatomegaly, and bleeding manifestations like haematuria, haemoptysis, melena, purpura, and internal bleeding.

Patients were assessed for baseline blood investigations, which encompassed complete blood count, liver function test, renal function test, serum electrolytes, prothrombin time, international normalized ratio, urine routine, and arterial blood gas. The cardiac condition of the patients was assessed using ECG. Subsequently, the patients were admitted and symptomatically treated with renoprotectives and hepatoprotectives.

The clinical profile of each patient was documented according to the Poison Severity Score. The complications of rodenticide poisoning, such as hepatotoxicity, nephrotoxicity, electrolyte imbalance, neurotoxicity, cardiotoxicity, and deranged coagulation profile, were assessed and noted in the proforma.

Blood investigations and ECG were repeated on the 3rd, 5th, and 7th days, followed by every alternate day until the patient was discharged. The complications, outcomes, average length of hospital stay, and mortality were documented.

The data obtained for incidence, clinical profile, complications, and outcome were subjected to statistical analysis.

Statistical Analysis:

Data from the case record proforma was entered into Microsoft Excel spreadsheet version 2026 and analyzed using IBM-SPSS version 26. Normality of the data was determined using Kolmogorov–Smirnov test. Categorical data was expressed as frequency and proportion (percentages). Numerical data was represented with mean and standard deviation for parametric data, or median and IQR in case on nonparametric data. For determining the statistical correlation in categorical data, a Chisquare test or Fisher Exact test was applied. To calculate significant mean difference for normally distributed continuous data, a student t-test was applied, whereas, for non-normal continuous data, the non-parametric test of Mann-Whitney U was applied. Pearson Correlation Coefficient was used calculate the correlation between tow variables. P-value < 0.05 will be considered significant for all statistical comparisons.

Table No. 1: Outcome Distribution Based on Time Interval Post-Ingestion

Table No. 2: Outcome Distribution Based on Amount of Rodenticide Ingested

Table No. 3: Outcome Distribution Based on Blood Pressure (BP) and Pulse Rate (PR) following Rodenticide Ingestion

Table No. 4: Outcome Distribution Based on Complications after Rodenticide Ingestion

This study aimed to evaluate the clinical manifestations, complications, and outcomes associated with rodenticide poisoning in a cohort of 100 patients. The data gathered provided insight into a range of factors, from basic demographics to intricate clinical parameters and outcomes. In our cohort, we observed a noteworthy recovery rate, with a majority of the subjects showing favorable outcomes despite the acute poisoning. Of the 100 subjects enrolled in the study, 95 exhibited successful recovery either with or without complications, while 5 faced an unfortunate demise. The following sections will provide a detailed breakdown of the demographics, clinical presentations, systemic examinations, laboratory findings, complications, and specific outcomes in relation to the type and amount of rodenticide ingested, duration since ingestion, and other relevant parameters.

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The implications of rodenticide ingestion remain a profound concern in toxicological and emergency medicine domains. This comprehensive study, which encapsulates a wide array of demographic and clinical parameters, provides an invaluable insight into the multifaceted determinants of outcomes following such poisonings.

Our analysis underscores the nuanced interplay between age, time post-ingestion, the nature and amount of rodenticide, clinical manifestations, and specific laboratory markers. Amongst the age groups, the younger population, specifically those between 13-32 years, demonstrated remarkable resilience and recovery potential. In contrast, the 33-42 age bracket, though constituting a smaller proportion of the total study, exhibited a disproportionate fatality rate, emphasizing the need for heightened clinical vigilance for this demographic.

The pivotal role of timely medical intervention was evident, with outcomes being most favorable when care was sought within the first two hours post-ingestion. This finding accentuates the importance of public awareness campaigns to emphasize the urgency of seeking immediate medical help following poison ingestion. Interestingly, late presentations, especially those after 24 hours, also carried a pronounced risk of mortality, hinting at the prolonged and cascading toxic effects of certain rodenticides.

While gender and marital status did not exhibit a marked influence on the outcomes, the nature, form, and quantity of the rodenticide ingested did. The data unveiled a significant risk gradient based on the amount consumed, emphasizing that dosages above 10 grams could critically augment fatality risk.

The clinical manifestations, such as the absence of bleeding and icterus, have been identified as positive prognostic markers, while the presence of specific symptoms like tachycardia heralded negative outcomes. This illuminates the importance of meticulous symptom evaluation in predicting the clinical course and emphasizes the need for rapid interventions tailored to these manifestations.

Laboratory parameters emerged as powerful tools in prognostication. Elevated levels of urea, creatinine, bilirubin, and certain coagulation parameters stood out as harbingers of adverse outcomes. These markers, which are reflective of organ dysfunction, emphasize the systemic ramifications of rodenticide toxicity. Intriguingly, some commonly evaluated parameters like total protein and certain liver enzymes did not vary significantly between the recovered and expired groups, suggesting their limited utility in this specific context.

In light of these findings, medical professionals should adopt a multifaceted approach when managing rodenticide ingestions. An integrative analysis, encompassing the patient's demographic details, clinical presentation, and laboratory findings, can guide therapeutic interventions, ensuring optimal outcomes. Moreover, this study's insights underline the need for concerted efforts in preventive strategies, from safe storage practices to public awareness campaigns, to minimize the incidence and repercussions of rodenticide poisonings.

Lastly, as with all research, our study has its limitations, and further investigations with larger cohorts across diverse geographies will fortify these findings. Yet, the revelations of this analysis remain an essential step towards enhancing our understanding, management, and prevention of rodenticide-related toxicities.

The relationship between rodenticide ingestion and its effect on various physiological parameters has been a topic of great concern, particularly given the toxic nature of rodenticides. Our comprehensive study sheds light on multiple facets associated with outcomes post-rodenticide consumption, encompassing demographic details, symptoms, clinical signs, and various laboratory parameters.

The age distribution of participants was particularly insightful. Majority of our study population was aged between 13-32 years, aligning with a study by Sharma et al., where the age group of 20-30 years was found to be most commonly affected by rodenticide ingestion. Moreover, the fatality rate in the 33-42 age group was alarming. This finding contrasts with a study by Jeyaratnam et al., where younger age groups were associated with a higher risk of mortality. The variation can be due to differences in the type of rodenticide, amount ingested, or the time lag in seeking medical attention.

No significant gender difference in outcomes was found in our study, echoing findings from Reddy and Singh.(8) However, some studies argue that women, particularly in certain Asian countries, may be at greater risk due to the intentional ingestion of rodenticides in suicide attempts. Marital status, though showing some variations, did not significantly influence outcomes in our study. It contrasts with a study by Kumar et al., where being unmarried was identified as a significant risk factor for rodenticide ingestion. This disparity could be attributed to sociocultural differences across regions. 82The urgency of seeking medical care post-ingestion was another major revelation from our study. Patients who sought treatment within the initial 2 hours of ingestion had a heightened risk of mortality, a result in line with Kumar et al., emphasizing the high toxicity of rodenticides and the rapid onset of symptoms. Late presentations, especially >24 hours post-ingestion, also culminated in elevated fatality rates, highlighting the importance of early intervention and possible complications due to delayed treatment.

Our study's assessment of the relationship between the type of rodenticide ingested and outcomes, although presenting intriguing results, did not find a significant association. This differs from results obtained by Patel et al., where Brodifacoum was associated with higher mortality rates compared to other rodenticides. Similarly, Bromodialone and Zinc Phosphide, which showed high fatalities in our study, were noted to have comparatively lower mortality rates in a study by Rathi et al.(9) Interestingly, the amount of rodenticide ingested emerged as a pivotal factor in determining outcomes. Ingestion of quantities exceeding 10 grams was highly fatal, whereas doses under 2 grams were considerably safer. This corroborates with Singh et al., where higher ingested amounts translated to worse outcomes. The physical form of the rodenticide (i.e., powdered) was significantly associated with both recoveries and fatalities. A similar result was observed in a study by Verma et al., which also emphasized the heightened risk associated with the powdered form. The form might influence the rate of absorption and thus the clinical presentation. Clinical signs post-ingestion such as vomiting, abdominal pain, fever, and breathlessness, although observed among the participants, didn't play a decisive role in predicting outcomes in our study. This contrasts with Sharma et al., where vomiting 83and abdominal pain post-ingestion were significant prognostic indicators.

The absence of bleeding and icterus were positive prognostic signs in our study, a finding consistent with observations made by Rathi et al. These clinical signs potentially indicate the body's overall capacity to manage the toxic effects of the rodenticide.

Elevated urea and creatinine levels were strongly linked to unfavorable outcomes in our cohort. Kidney dysfunction, as indicated by these markers, has been associated with poor outcomes in several studies, including the one by Ahmed et al.(10) The role of liver function tests was elucidated effectively in our study. Elevated levels of bilirubin and ALT/AST were significant markers for poor outcomes, consistent with findings by Patel et al.6. Similarly, coagulation parameters like PT and APTT played a significant role in predicting outcomes, a result paralleling observation by Rajpal et al. (11) Our observations regarding CBC mirrored those from Varma and Kumar, emphasizing the importance of a normal CBC as a prognostic indicator. Anemia and thrombocytopenia were seen more often among the expired group, further underscoring their relevance.

Our study provides a comprehensive analysis of factors influencing outcomes post- rodenticide ingestion. Early medical intervention, the amount of rodenticide consumed, and specific laboratory parameters stand out as crucial determinants. Comparisons with previous studies enrich our understanding, although regional and sociocultural variations warrant more localized research. Physicians must remain vigilant and utilize these findings to optimize patient management.

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