Substance | Appearance | Minimum lethal dose | Clinical findings | Management |
Thallium | Odorless, tasteless powder Radiopaque | 8 mg/kg | Early: abdominal pain, vomiting, constipation, tachycardia, hypertension, and chest pain Intermediate: painful stocking-glove paresthesias, ptosis, nystagmus, ataxia, chorea, delirium, psychosis, coma, alopecia, erythema of palms and soles Other: Acute kidney injury, hepatotoxicity, anemia with thrombocytopenia, hyperchloremic metabolic acidosis |
|
Sodium monofluoroacetate or fluoroacetamide | Odorless, tasteless, white powder | 2 mg/kg | Respiratory distress, refractory shock, agitation, hypocalcemia with seizures and cardiac arrhythmias, severe lactic acidosis, vomiting, diarrhea, and abdominal pain, paresthesias |
|
Strychnine¶ | Colorless, odorless, bitter when dissolved in water. | 1 mg/kg | Rapid onset of hyperreflexia, clonus, stiffness of facial and neck muscles, repetitive grimacing (risus sardonicus), trismus, opisthotonus |
|
Zinc or aluminium phosphide | Gray or black powder; Gray, green, or turquoise pellets or tablets Radiopaque | ~50 mg/kg (Not well established) | Vomiting with fishy odor, hematemesis, chest and abdominal pain, refractory shock, brady- and tachyarrhythmias, hemorrhagic pulmonary edema |
|
White (yellow) phosphorus | Yellow, waxy solid compound | 1 mg/kg | Perioral, mucosal, and skin burns, vomiting, diarrhea, garlic odor on breath, phosphorescent emesis or stool, delayed liver failure, acute kidney injury Lung irritation with inhalation |
|
ArsenicΔ | White powder, odorless and tasteless Radiopaque | 1 mg/kg | Acute: Vomiting, watery diarrhea, garlic odor on breath, QTc prolongation, torsades de pointes, coma, seizures Chronic: Refer to UpToDate topic on Arsenic poisoning |
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Barium carbonate | White powder | 20 mg/kg | Vomiting, diarrhea, abdominal pain, severe hypokalemia with weakness, paralysis, and ventricular arrhythmias, hypertension |
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Vacor | Similar to cornmeal, peanut odor | 5 mg/kg | Hyperglycemia, ketoacidosis, postural hypertension, weakness, cranial neuropathy, lethargy, delirium |
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Tetramine (banned but available, especially in China) | Odorless, tasteless, white powder | <0.1 mg/kg | Refractory status epilepticus |
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Aldicarb (banned, but available, especially in Latin America) | Sulfur odor, solid pellets, gray to black | <0.8 mg/kg | Bronchorrhea, bronchospasm, bradycardia, salivation, diarrhea, vomiting, small pupils, urination; weakness and paralysis with high doses |
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Alpha-chloralose | White powder | Not established in humans | Respiratory depression, coma, myoclonus |
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Salmonella-based (most available in South America, withdrawn from Europe and US markets) | Rice grains | Not established in humans | Salmonella enteritis and invasive Salmonella disease | Refer to UpToDate topics on management of non-typhoid Salmonella enteritis |
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