Follow-up testing to identify presence of the toxin can be used to avoid future exposure to others. Most cases of rodenticide exposures do not require an ED visit, because there is residual vitamin K production by the bowel flora. Patients having prolonged bleeding times which are responsive for 2-3 days on vitamin K therapy, and return to a condition of prolonged bleeding times, should be evaluated for exposure to anticoagulants. Samples should be collected at 24-36 hours after exposure to monitor anticoagulation effects. Acute exposure to lead produces anemia and gastrointestinal distress, while chronic exposure interferes with mental development, bone growth, nerve function, and causes nephropathy.
Young children are particularly sensitive to the effects of lead.
Since the serious sequelae associated with lead occurs with chronic exposure, the work-up usually takes place in the outpatient setting. Emergency testing for lead is not required to support the ED practice. Collection of serum for lead evaluation is not appropriate. The EPP test does not have the sensitivity for low level lead exposure, but is a marker for overdose. Serum lead analysis has no clinical utility in cases of acute lead exposure because serum lead concentrations are abnormal only for a short period of time after exposure.