title: Aldicarb poisoning by an illicit rodenticide imported into the United States: Tres Pasitos.
abstract: OBJECTIVE
  Although intentional and unintentional rodenticide poisoning is common, most readily available agents are of relatively low acute toxicity. A four-year long epidemic of severe toxicity from rodenticide exposure continues among patients predominantly of Dominican descent living in New York City. This study characterizes the ongoing epidemic of acute cholinesterase inhibitor poisoning due to an illicit rodenticide and identifies its etiology.
  
  
  METHODS
  A prospectively collected case series of poisoned patients referred to the New York City Poison Control Center. The main outcome measures include the clinical characteristics upon presentation, antidotal and other therapeutic requirements, and patient outcome. Product analysis was 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. Patients developed signs of cholinergic hyperactivity and many required high doses of atropine (>10 mg) to control these symptoms. The source was identified as a rodenticidal compound sold illicitly in local groceries primarily within the Dominican community. Murine cholinesterase activity fell significantly following exposure to the rodenticide. High-performance liquid chromatography identified aldicarb, an extremely potent carbamate-type cholinesterase inhibitor, not licensed for rodenticidal use in this country.
  
  
  CONCLUSIONS
  Illicit sale of undocumented compounds poses a substantial public health threat. Despite several public health interventions, the epidemic continues.
authors.affiliation: New York City Poison Control Center, New York University School of Medicine, New York 0016, USA. lnelson@pol.net
authors.forename: L S
authors.initials: LS
authors.lastname: Nelson
authors.forename: J
authors.initials: J
authors.lastname: Perrone
authors.forename: F
authors.initials: F
authors.lastname: DeRoos
authors.forename: C
authors.initials: C
authors.lastname: Stork
authors.forename: R S
authors.initials: RS
authors.lastname: Hoffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000448:Aldicarb / Q000506:poisoning*; D000818:Animals; D001285:Atropine / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000506:poisoning; D002801:Cholinesterase Reactivators / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D002854:Chromatography, Paper; D004196:Disease Outbreaks; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007223:Infant; D008297:Male; D051379:Mice; D009519:New York City; D011220:Pralidoxime Compounds / Q000627:therapeutic use; D011446:Prospective Studies; D012378:Rodenticides / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D002801:Cholinesterase Reactivators; D011220:Pralidoxime Compounds; D012378:Rodenticides; D001285:Atropine; D000448:Aldicarb; C028797:pralidoxime