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Sodium Fluoroacetate Poisoning

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Sodium Fluoroacetate Poisoning, Sodium Fluoroacetate Toxicity, Sodium fluoroacetate

  • Background
  1. Sodium fluoroacetate has since 1985, restricted use in the U.S. on livestock collars as a predacide (toxic to predators, such as coyotes)
  2. Sodium fluoroacetate was originally used in U.S. as a rodenticide and to kill coyotes from 1940 to 1985
  3. Fluoroacetate is found naturally in Gastrolobium flowering plants of Australia, as well as other plant species in New Zealand, Brazil and Africa
  4. Sodium fluoroacetate is highly toxic to mammals including humans
    1. Fluoroacetate is structurally similar to acetate, entering the Kreb Cycle with its derivative tightly binding aconitase, and blocking further activity
  • Pharamacokinetics
  1. Oral lethal dose >2 mk/kg
    1. Rapid absorption
    2. Also toxic via inhalation or absorption via broken skin
  • Symptoms
  1. Gastrointestinal
    1. Nausea or vomting
    2. Abdominal Pain
  2. Respiratory
    1. Decreased respiratory effort
  3. Cardiovascular
    1. Hypotension
    2. QT Prolongation
    3. Ventricular Tachycardia
  4. Neurologic
    1. Agitation
    2. Cerebellar dysfunction
    3. Seizure
    4. Altered Mental Status (coma)
  5. Metabolic
    1. Hypocalcemia
    2. Hypomagnesemia
    3. Acidosis
  • Labs
  1. See Unknown Ingestion
  2. Comprehensive metabolic panel
  3. Serum Calcium
  4. Serum Magnesium
  5. Electrocardiogram
  • Management
  1. Activated Charcoal in early presentations (first few hours) if no airway compromise or other contraindications
  2. Supportive care
    1. Supplemental Oxygen as needed
    2. Blood Pressure support
      1. Intravenous Fluids
      2. Norepinephrine in refractory Hypotension
    3. Seizure
      1. Benzodiazepines
      2. Barbiturates
      3. Propofol
    4. Electrolyte replacement for deficits
      1. Calcium Gluconate
      2. Magnesium Sulfate
    5. Other experimental measures to consider
      1. Intravenous Lipid Emulsions
      2. Methylene blue
  3. Disposition
    1. May discharge patients who remain asymptomatic at 4 hours
    2. Admit all symptomatic patients
  • Resources
  1. Sodium fluoroacetate (Wikipedia)
    1. https://en.wikipedia.org/wiki/Sodium_fluoroacetate
  • References
  1. Tomaszewski (2022) Crit Dec Emerg Med 36(12): 32