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