Aldicarb poisoning bay an illicit rodenticide imported into the United States: Tres Pasitos

Objective: Although intentional and unintentional rodenticide poisoning is common, most readily, available agents are of relatively, low acute toxicit y. A four-year long epidemic of severe toxicity from rodenticide exposure c ontinues among patients predominantly, of Dominican descent living in New Y ork City. This study, characterizes the ongoing epidemic of acute cholinest erase inhibitor poisoning due to an illicit rodenticide and identifies its etiology. Methods: A prospectively, collected case series of poisoned patie nts referred to the New York City Poison Control Center. The main outcome m easures include the clinical characteristics upon presentation, antidotal a nd other therapeutic requirements, and patient outcome. Product analysis wa s performed with paper chromatography, gas chromatography/mass spectrometry , and high-performance liquid chromatography. A murine model assessing both clinical effect and cholinesterase activity, was also performed. Results: Thirty-five patients were referred following exposure to Tres Pasitos. Pati ents developed signs of cholinergic hyperactivity and many, required high d oses of atropine (> 10 mg) to control these symptoms. The source was identi fied as a rodenticidal compound sold illicitly in local groceries primarily within the Dominican community. Murine cholinesterase activity fell signif icantly following exposure to the rodenticide. High-performance liquid chro matography identified aldicarb, an extremely potent carbamate-type cholines terase inhibitor, not licensed for rodenticidal use in this country. Conclu sion: Illicit sale of undocumented compounds poses a substantial public hea lth threat. Despite several public health interventions, the epidemic conti nues.