Strychnine poisoning: uncommon, but does still happen

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 159; p. A8877
• Main Authors: van Berlo-van de Laar, Inge R F, Arbouw, Maurits E L, Bles, Carmen M A
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2015
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - therapy; Emergency Treatment; Epilepsy, Tonic-Clonic - chemically induced; Epilepsy, Tonic-Clonic - therapy; Fever; Humans; Male; Midazolam - therapeutic use; Middle Aged; Poisoning - diagnosis; Poisoning - therapy; Rhabdomyolysis - chemically induced; Rhabdomyolysis - therapy; Strychnine - poisoning
• ISSN: 0028-2162; 1876-8784

Acute strychnine poisoning is an uncommon form of intoxication, characterized by severe tonic clonic seizures and tetanus-like contractions while the patient is fully conscious. It can result in respiratory failure, leading to death. A 47-year-old man was admitted to the casualty department 2 hours after self-poisoning with strychnine. The clinical picture consisted of persistent seizures, which were treated with midazolam and propofol. The patient went into respiratory failure and asystole, so intubation and cardiac massage were initiated. Other complications were severe metabolic acidosis, hyperthermia and rhabdomyolysis with renal failure. The treatment consisted of cooling, hyperhydration and intravenous administration of sodium bicarbonate. He was discharged to a mental care institution with no persistent symptoms 11 days later. Early aggressive treatment of a strychnine intoxication can be life-saving. Knowledge of the clinical picture and the right treatment is important. Treatment is primarily focussed on stopping the convulsions and securing the airway.