Rodenticides have historically been common agents in attempted suicides. As most
rodenticides in the United States (U.S.) are superwarfarins, these ingestions are generally managed conservatively with close monitoring for coagulopathy, and if necessary, correction of any resulting coagulopathy. However, alternate forms of
rodenticides are imported illegally into the U.S. and may be ingested either accidentally or in suicide attempts. We present an unusual case of
poisoning by the illegally imported
rodenticide, "Tres Pasitos." The main ingredient of this rat
poison is
aldicarb, a potent
carbamate pesticide that causes fulminant
cholinergic crisis. This case is relevant and timely because
carbamates and
organophosphates are still used as
insecticides and emergency physicians (EP) working in rural areas may have to evaluate and manage patients with these
poisonings. As international travel and immigration have increased, so has the possibility of encountering patients who have ingested toxic substances from other countries. In addition, there has been increased concern about the possibility of acts of terrorism using chemical substances that cause
cholinergic toxidromes.1,2 EPs must be able to recognize and manage these
poisonings. This report describes the mechanism of action, clinical manifestations, laboratory evaluation and management of this type of
poisoning. The pertinent medical literature on
poisoning with
aldicarb and similar substances is reviewed.