Bromethalin

Bromethalin is a new rodenticide for the control of commensal rodents; doses in excess of the LD50 (2 mg/kg in rats) will cause death.

Atypical bromethalin intoxication in a dog: pathologic features and identification of an isomeric breakdown product.[Pubmed:26419228]

BMC Vet Res. 2015 Sep 28;11:244.

BACKGROUND: Definitive post mortem confirmation of intoxication by the neurotoxic rodenticide Bromethalin can be challenging. Brain lesions are not specific and detection of Bromethalin and its metabolites are unpredictable due to rapid photodegradation and inconsistent behavior in tissues. CASE PRESENTATION: A 2-year-old dog presented with rapid onset of severe muscle tremors and death within hours after a known ingestion of a reportedly low dosage of Bromethalin and subsequent decontamination using activated charcoal. Marked meningeal hemorrhages and multifocal myelin sheath vacuolation were observed in the brain. A marked reactive astrocytosis and neuronal hypoxia/necrosis were identified using immunohistochemistry (IHC) for glial fibrillary acidic protein (GFAP) and for neuron specific protein (NeuN). Bromethalin exposure and tissue absorption was confirmed by identification of one of two isomeric 543.7 molecular weight (MW) breakdown products in the patient's adipose and kidney samples using gas chromatography (GC) combined with tandem quadrupole mass spectrometry (MS/MS). CONCLUSIONS: The severity of clinical signs and subsequent death of this dog was not expected with the low dosage of Bromethalin reportedly ingested, and the use of activated charcoal possibly precipitated a hypernatremic status. Meningeal hemorrhages are atypical of Bromethalin intoxication, and might have been caused by hyperthermia, secondary to tremors or hypernatremia. Identification of one of two isomeric breakdown products in the adipose tissue and kidney provides an additional molecule to the toxicologic testing regime for Bromethalin intoxication.

Human bromethalin exposures reported to a U.S. Statewide Poison Control System.[Pubmed:26860212]

Clin Toxicol (Phila). 2016 Mar;54(3):277-81.

BACKGROUND: Bromethalin is an increasingly used alternative to long-acting anticoagulant and cholecalciferol rodenticides. There are few reports of human exposures, and no existing professional society guidelines on medical management of Bromethalin ingestions. The aim of this retrospective data review is to characterize Bromethalin exposures reported to the California Poison Control System (CPCS) between 1997 and 2014. METHODS: This is an observational retrospective case review of our statewide poison control system's electronic medical records. Following Institutional Board Review and Research Committee approvals, poison center exposures related to Bromethalin were extracted using substance code and free text search strategies. Case notes of Bromethalin exposures were reviewed for demographic, clinical, laboratory, and outcome information; inclusion criteria for the study was single-substance, human exposure to Bromethalin. RESULTS: There were 129 calls related to human Bromethalin exposures (three cases met exclusion criteria). The age range of cases was 7 months-90 years old, with the majority of exposures (89 cases; 70.6%), occurring in children younger than 5 years of age (median age of 2 years). Most exposures occurred in the pediatric population as a result of exploratory oral exposure. One hundred and thirteen patients (89.7%) had no effects post exposure, while 10 patients (7.9%) had a minor outcome. Adverse effects were minor, self-limited, and mostly gastrointestinal upset. There were no moderate, major, or fatal effects in our study population. The approximate ingested dose, available in six cases, ranged from 0.067 mg/kg to 0.3 mg/kg (milligrams of Bromethalin ingested per kilogram of body weight), and no dose-symptom threshold could be established from this series. Exposures were not confirmed through urine or serum laboratory testing. DISCUSSION: The prognosis for most accidental ingestions appears to be excellent. However, Bromethalin exposures may result in a higher number of symptomatic patients than long-acting anticoagulant agents. Parents, physicians and poison control specialists are encouraged to maintain a high index of suspicion for Bromethalin-related complications in all cases of rodenticide exposures. CONCLUSIONS: Accidental Bromethalin exposures in children appear to be self-limited in toxicity. Additional studies are warranted to determine whether more severe effects are precipitated when larger amounts are involved, particularly in suicidal ingestion.

Intravenous Lipid Emulsion Therapy for Bromethalin Toxicity in a Dog.[Pubmed:27259025]

J Am Anim Hosp Assoc. 2016 Jul-Aug;52(4):265-8.

Bromethalin is a central nervous system toxin currently incorporated into several different rodenticides. In 2008, the EPA requested that manufacturers phase out second-generation anticoagulant rodenticides. In response, manufacturers began to increase production of Bromethalin-based rodenticides. It is likely that pet exposure to Bromethalin will increase in the future. Bromethalin has no known antidote and tends to deposit in fat. Intravenous lipid emulsions (ILEs) are being used with increasing frequency in both human and veterinary medicine to treat numerous acute systemic toxicities. A 4 yr old spayed female Pit bull terrier was presented following witnessed ingestion of Bromethalin rodenticide by the owners. Decontamination was unsuccessful and ILE was started. Serum was frozen at -80 degrees C before and 1 hr after completion of ILE. In rats, the half-life of desmethylBromethalin, the toxic metabolite, has been reported at 5.6 days and 6 days, and it is likely to be similar in dogs. The only intervention between the pre-lipid serum sample and the post-lipid serum sample was the administration of ILE, and the serum desmethylBromethalin levels were reduced by 75% (from 4 ppb to 1 ppb) during this time. To the authors' knowledge, this is the first report describing treatment of Bromethalin ingestion with ILE.

Bromethalin is a new rodenticide for the control of commensal rodents; doses in excess of the LD50 (2 mg/kg in rats) will cause death.

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