A Case of Altered Mental Status in the Setting of Bromethalin Toxicity

Bromethalin is one of four different types of rodenticide ingredients. Accidental or intentional ingestion of that poison can cause serious symptoms and signs that would require hospitalization and might lead to death. It works by depleting ATP from brain and liver mitochondria by uncoupling of oxidative phosphorylation process which leads to disruption of the function of sodium/potassium ion pumps in those organs causing cerebral edema with intracranial hypertension. Our case presented with altered mental status after patient was found down in his car with green discoloration around mouth and holding Tomcat rat poison in one hand and a bottle of Vodka on the other hand. Patient was intubated and admitted to ICU. Supportive care was started and later on was weaned off mechanical ventilation and improved over the course of his hospital stay.