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Intoxication with sodium monofluoroacetate (compound 1080)
Renee F Robinson1, Jill R Griffith, William R Wolowich
1Pediatric Pharmacotherapy/NIH Clinical Research K30 Program, College of Pharmacy, The Ohio State University, Childrens Research Institute, The Central Ohio Poison Control Center, Columbus 43210, USA.
Abstract:
The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in the U.S. in 1972. We report the first case of intentional ingestion in this country in over 15y. A 47-y-old male was brought to the emergency room status post tonic clonic seizure. At 34 h post ingestion, he responded ony to noxious stimuli and at 48 h, he was unresponsive to painful stimuli, was intubated and placed on a ventilator. Over the following 3 d, he was became minimally responsive to external stimuli with bouts of agitation and hypertension. Two days later he was discharged with no evidence of neurologic sequelae. We report this patient to increase awareness of SMFA toxicity, and its ability to cause anion gap metabolic acidosis.
Insights
Intentional ingestion of sodium monofluoroacetate (SMFA), a banned rodenticide, caused severe toxicity, including seizures and anion gap metabolic acidosis. This case highlights the importance of recognizing SMFA poisoning despite its restricted use.
Area of Science:
- Toxicology
- Emergency Medicine
- Clinical Case Reports
Background:
- Sodium monofluoroacetate (SMFA) is a highly toxic compound previously used as a rodenticide in the U.S. and banned in 1972.
- Intentional ingestion of SMFA is rare, with this case representing the first reported instance in the U.S. in over 15 years.
Observation:
- A 47-year-old male presented with a tonic-clonic seizure following intentional SMFA ingestion.
- The patient exhibited progressive neurological decline, requiring intubation and mechanical ventilation.
- Clinical course included agitation, hypertension, and anion gap metabolic acidosis.
Findings:
- The patient demonstrated severe central nervous system toxicity and metabolic derangement consistent with SMFA poisoning.
- Despite the severity of initial symptoms, the patient experienced a remarkable recovery without apparent neurological sequelae.
- Recovery occurred over several days with supportive care, including mechanical ventilation.
Implications:
- This case underscores the persistent risk of SMFA toxicity, even after its ban, emphasizing the need for heightened awareness among healthcare professionals.
- Early recognition and management of SMFA poisoning are crucial for patient survival and preventing long-term complications.
- The case highlights SMFA's potential to induce severe anion gap metabolic acidosis and profound neurological impairment.