Organophosphates are usually dissolved in hydrocarbon bases; thus, the clinician should be prepared to treat potential hydrocarbon pneumonitis Carbamate insecticides have a similar mechanism of action to organophosphate insecticides but the phosphorylation of acetylcholinesterase is reversible and temporary Pralidoxime therapy is generally regarded as unnecessary after poisoning from carbamates Rodenticides Long-acting vitamin K antagonists (VKAs) are commonly used rodenticides They work similarly to warfarin anticoagulants by inhibition of the vitamin K cycle, leading to a reduction in the cyclic activation of vitamin K, which is an essential cofactor in the synthesis of clotting factors II, VII, IX, and X Because long-acting VKAs are highly lipid soluble and concentrate in the liver, they are more potent and have a significantly longer duration of action than warfarin Intentional ingestions of long-acting VKAs can lead to severe, prolonged coagulopathy lasting weeks to months Patients with acute intentional ingestions should have daily INR testing for days to monitor for development of coagulopathy Those with coagulopathy require acute management of bleeding and prolonged treatment with high doses of vitamin K However, children with unintentional ingestions are unlikely to develop coagulopathy due to the small amount ingested in a taste of a rodenticide pellet Therefore, children with small unintentional exposures should have follow-up with an INR 48 to 72 hours after exposure A baseline INR is usually not necessary unless there is concern for chronic exposure or underlying coagulopathy See Table 102.17 for a summary of other rodenticides and their toxicities