A case report on Ratol paste poisoning in addition with oleander buds

Rodenticide poisoning, particularly with yellow phosphorus-based formulations like Ratol paste, poses a significant public health challenge in rural India due to its widespread availability and high toxicity. This report describes a fatal case of suicidal poisoning involving a 20-year-old male who ingested a lethal dose of Ratol paste alongside oleander buds. Despite prompt medical interventions, including gastric lavage, intravenous N-acetylcysteine (NAC), vitamin K, plasmapheresis, and supportive care, the patient succumbed to progressive hepatic encephalopathy, coagulopathy, and septic shock. Yellow phosphorus, present in Ratol paste, is a potent toxin that rapidly affects multiple organ systems, primarily targeting the liver. Its mechanism includes disruption of fatty acid oxidation and ATP production, leading to severe hepatic and systemic toxicity. Oleander ingestion exacerbated the condition due to its additional cardiotoxic properties. The case underscores the critical need for stringent regulation of hazardous substances like Ratol paste and enhanced public awareness to mitigate accidental and intentional poisoning incidents.