The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in the U.S. in 1972. We report the first case of intentional ingestion in this country in over 15y. A 47-y-old male was brought to the emergency room status post tonic clonic seizure. At 34 h post ingestion, he responded ony to noxious stimuli and at 48 h, he was unresponsive to painful stimuli, was intubated and placed on a ventilator. Over the following 3 d, he was became minimally responsive to external stimuli with bouts of agitation and hypertension. Two days later he was discharged with no evidence of neurologic sequelae. We report this patient to increase awareness of SMFA toxicity, and its ability to cause anion gap metabolic acidosis.