Introduction: Sodium fluoroacetate (“1080”) is a rodenticide used to kill rodents, prohibited in Europe but still present in certain territories and used in some countries. It is characterized by high toxicity, with no effective antidote currently available.

Case report: We report the case of a 23-month-old infant admitted to the emergency department for status epilepticus associated with vomiting and febrile episodes. The child was sedated, intubated, and admitted to the intensive care unit.

Initial laboratory investigations revealed severe high-anion-gap metabolic acidosis associated with marked hypocalcemia. Urinary toxicology screening was negative.

The infant’s condition rapidly deteriorated, with hemodynamic failure, oligo-anuric renal failure, and worsening hypocalcemia. The clinical course was characterized by cardiac arrest, recurrence of acidosis, refractory hypocalcemia, hyperammonemia, right-sided cardiac failure, and refractory ventricular arrhythmias.

The outcome was rapidly fatal, with death occurring approximately 56 hours after symptom onset.

In view of the unexplained fatal outcome, a forensic autopsy with complementary toxicological and microscopic examinations, was performed.

The autopsy revealed no gross lesion capable of explaining the infant’s death. Likewise, histopathological examination of the collected samples revealed no abnormality that could explain the death. In contrast, toxicological analysis of biological matrices collected at autopsy demonstrated the presence of sodium fluoroacetate.

Conclusions: Sodium fluoroacetate poisoning, although rare, is extremely severe and should be considered in the presence of a compatible toxidrome. A negative urinary toxicology screen does not exclude a specific poisoning.

Any unexpected infant death requires systematic investigation and an appropriate forensic evaluation.