From the Research
Strychnine is a highly toxic alkaloid compound that can cause severe muscle spasms, rigidity, and potentially death through respiratory failure, and its treatment requires immediate medical attention and focuses on controlling seizures, maintaining respiratory function, and providing supportive care. The symptoms of strychnine poisoning include violent muscle contractions, facial contortions, arched back (opisthotonus), and extreme sensitivity to stimuli, with consciousness typically remaining intact until death 1. Historically, strychnine was used in very small doses as a stimulant, appetite stimulant, and athletic performance enhancer, but its therapeutic use has been abandoned due to its extreme toxicity and narrow therapeutic window 2. Some key points to consider when treating strychnine poisoning include:
- Aggressive airway control and treatment of seizures with benzodiazepines or barbiturates 2
- Neuromuscular blockade may be required 2
- Gastrointestinal decontamination is usually indicated in recent acute ingestions but may precipitate convulsions 2
- Recovery from strychnine poisoning is usually complete and rapid if treatment is aggressive 2
- Confirmation of strychnine poisoning is best obtained by submitting urine or gastric aspirate for analysis utilizing a qualitative test such as thin layer chromatography (TLC) 2 The most recent study on strychnine poisoning, published in 2011, reminds clinicians of the features and management of this increasingly rare presentation, and highlights the importance of prompt recognition and early intensive supportive therapy to result in a favourable outcome 1. In terms of toxicokinetics, strychnine competes with the inhibitory neurotransmitter glycine producing an excitatory state characterized clinically by hyperreflexia, severe muscle spasms, and convulsions, and its disappearance follows a first-order process with a half-life of 10-16 hours 3. Overall, strychnine poisoning is a serious and potentially life-threatening condition that requires immediate medical attention and aggressive treatment to prevent morbidity and mortality.