What Is Strychnine?
Strychnine, an odorless chemical and commercially used salt, is a naturally occurring alkaloid derivative of the plant strychnos nux vomica. This was used to treat specific ailments in the past, but presently and commercially, it is used for pest control, especially for rodent eradication like rat poisons. The absorption, inhalation, ingestion, or swallowing through the human eyes or mouth can be life-threatening and fatal. It produces noticeable and poisonous effects almost immediately with painful clinical onset, rigidity and may cause respiratory failure, brain cell damage, and toxicity resulting in death. In high doses of strychnine poisoning, the failure to immediately rush the patient to an emergency ward or follow basic emergency protocols for the patient to survive the effects of poisoning, might result in death within a span of 15 to 30 minutes.
Strychnine is used in illegal sports to enhance performance (though little evidence exists that strychnine can improve athletic performance, sporting deaths by strychnine poisoning have been reported in the 19th century). Adulteration of illicit drugs like heroin, cocaine, LSD (lysergic acid diethylamide), especially for the taste and local anesthetic effect of this chemical, has led to strychnine poisoning in the past and in street or illicit drug consumers now. Especially in chronic users of amphetamine, Cocaine, or other illegal drugs, the patient's medical history helps the healthcare provider or physician intervene early for both diagnosis and treatment planning to help the affected individual counteract the long-term effects of poisoning on systemic health.
What Are the Clinical Symptoms of Strychnine Poisoning?
Due to these fatal reasons, contemporary use of this poisonous chemical is limited only to rat poisons or rodent poisons like gophers and moles. Unintentional ingestion or intentional or direct deliberate ingestion of this chemical can produce fatal and rapid clinical features within a few minutes of exposure.
The clinical manifestations of strychnine poisoning also mimic tetanus. Still, the distinguishing factor in tetanus is that it is not so rapid, nor does muscle rigidity exist instantly in the convulsive episodes or spasms. The hallmark or rather a significant characteristic of this poisoning is the sudden dawn of diffuse contractions (involuntary). The neck and back muscles may be arched or severely contracted (opisthotonus). The jerking of upper and lower extremities involuntarily can also prompt the observer to suspect poisoning of the individual.
Facial spasms and raised or elevated eyebrows are also common in spasm episodes that occur within an hour of exposure to strychnine. Muscular convulsive seizures yet alertness for a few minutes before having difficulty breathing is a classic sign demonstrated in this poisoning. The poisoned individual may be awake and, in fact, be conscious for a while, being aware of the symptomatic dawn of painful agitated and rigid episodes and arching of back and neck or opisthotonus. Still, difficulty in breathing can turn severe in a few minutes if emergency help has not arrived or is not given instantly, which can even result in death.
Jaw tightness, muscle soreness, and painful jaw contractions are also clinical responses to mild or moderate strychnine poisoning. Long-term effects because of abnormally low oxygen saturation levels even in mild to moderate poisoning cases can impact the long-term recovery of these individuals.
What Is the Pathophysiology or Mechanism of Strychnine Poisoning?
The stimulatory nerve signals responsible for muscle regulation and proper reflex action are inhibited completely by strychnine. The glycine chloride channel in the spinal cord has glycine receptors. The primary function of glycine binding in normal nerve physiology is to propagate nerve signals or nerve signaling and transmission. The reflex arc for involuntary reflexes is mainly by the nerve fibers in the spinal cord. In the altered pathophysiology of this strychnine poisoning, firstly, the chemical blocks glycine binding to the spinal cord's chloride channel receptors, thus causing hyperpolarization and inability to transmit nerve impulses or signals. Secondly, the typical reflex arc gets accentuated, causing excitation of nerve fibers of the spinal cord and muscle contractions that are irregulatory in nature.
How Is Strychnine Poisoning Managed?
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Immediately wash the palms and hands contaminated with strychnine with large amounts of soap and water efficiently.
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If the exposure is to the eye, the eyes should be rinsed with plain water for 10 to 15 minutes.
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As soon as an individual is found to be a victim or is suspected to be suffering from strychnine poisoning, the awareness should be to dial emergency hospital services.
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The individual should never be forced to vomit or drink water as both can increase the mortality risk.
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The emergency ward of the hospital has to attend the patient immediately. Evacuation and outdoor shelter should be sought if strychnine is released in the air.
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Clothing of the individual suspected to be exposed to strychnine poisoning should be cut off from the patient's body rather than pulling it over the individual's head as that can prevent further ingestion or exposure into the eyes or face.
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The contaminated clothing cannot be touched even by the person getting rid of it via the bare skin surfaces like the palm of a hand.
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While removing the clothes, the person should either wear gloves or the clothing should be removed using a stick or handle and then tightly sealed into a plastic bag and handed over to the local emergency or the hospital authorities. This is done to protect the immediate surroundings from the remnant exposure to strychnine.
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Supportive care and ventilation will help a patient if immediately rescued on time to prevent airway compromise.
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Control of the muscular spasms with an aggressive form of benzodiazepine therapy or intravenous crystalloid combined with sodium bicarbonate to prevent kidney failure is the standard modality employed in emergencies.
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Suppose the patient is suspected to be intentionally exposed to strychnine poisoning. In that case, monitoring after recovery for several days post-treatment and psychiatric evaluation of the individual will help in better prognosis.
Conclusion
To conclude, strychnine exposure, either accidentally, intentionally, or unintentionally in human beings, can be fatal to life and needs prompt attention and emergency admission. Recognition of early-onset symptoms can be instrumental in admitting the patient quickly to avoid the long-term respiratory and systemic impact of strychnine poisoning.
