Strychnine Poisoning: Causes, Symptoms, Treatment, and Prevention

Introduction

Strychnine is a compound that can cause toxicosis. In olden days, it was used as a medicine for many health issues. Strychnine poisoning is found to occur very rarely, but it is seen occasionally in the United States. Strychnine can cause serious effects with even very small doses of strychnine. It causes painful muscle contractions that mimic seizures.

What Is Strychnine Poisoning?

Strychnine is a white powder alkaloid derived from the seeds of the tree Strychnos nux vomica. It was used as an antiseptic, stomach tonic, circulatory stimulant, and central nervous system stimulant.

Recently, it has been used as a poison for animal control. Pharmacologically, it is a competitive antagonist of glycine. Glycine is an inhibitory neurotransmitter in the ventral horns of the spinal cord, brain stem, and higher centers. Strychnine is found to inhibit postsynaptic glycine receptors in the spinal cord, thereby causing painful involuntary muscle contractions.

Strychnine poisoning occurs due to accidental or intentional intake of this compound. Sometimes this poisoning may occur due to the unintentional intake of Chinese or Cambodian herbal remedies. This poison occurs when ingested orally. Some reported cases have been found to occur due to intravenous injection or intranasal insufflation via Cocaine and Heroin.

Strychnine was used as a rodenticide in Germany in the 16th century. By the early 1900s, it was available in the form of pills. It caused most of the deaths because of suicidal or unintentional ingestion in the United States. Strychnine poisoning cases have drastically reduced since it was eliminated from the list of non-prescription preparations in 1962.

Strychnine poisoning is found to be uncommon. The severely affected person may die before reaching the hospital. Straightening when ingested, it is rapidly absorbed by the mucus membrane. It is absorbed in the stomach and small intestine and eliminated by the kidneys and liver.

What Is the Mechanism of Strychnine Poisoning?

Strichnoine is a competitive inhibitor of the postsynaptic glycine receptor in the spinal cord. Hence, when strychnine is exposed, it stops the glycine that controls nerve signals to the muscles from working. This may lead to painful muscle spasms throughout the body.

Initially, the affected person’s consciousness or thinking is not affected, but the person is excitable and in pain. As time passes, eventually, the muscles get tired, and a person’s breathing may be affected.

What Are the Signs and Symptoms of Strychnine Poisoning?

Symptoms of strychnine poisoning develop after 15 to 30 minutes of ingesting strychnine orally. Symptoms may develop faster in other routes, such as intravenous injection or intranasal insufflation.

Initial symptoms include excitability and heightened awareness. Symptoms following these initial symptoms are vomiting and muscle contractions.

Convulsions last 30 seconds to two minutes. In such convulsions, the body posture changes to opisthotonic posture, which can be described as the back being arched, extremities extended, and the jaw clenched.

The affected individual may exhibit risus sardonicus (muscle contractions of the face cause a fixed or stiff smile.

Uncontrolled muscle contractions may lead to many conditions, such as:

• Tachycardia (heart beats faster than normal).

• Hyperthermia (body temperature is abnormally high).

• The airway may get compromised due to the stiffness of the facial and neck muscles.

• Rhabdomyolysis.

• Hyperkalemia (a condition in which too much potassium is present in the blood).

• Lactic acidosis (lactic acid buildup in the bloodstream).

• Metabolic acidosis (too much acid in the body fluids).

• Kidney failure.

• Seizures.

There is a chance of respiratory failure, as the muscles are spasmed. If strychnine poisoning is not checked, the affected person may die within several hours of ingestion.

How to Diagnose Strychnine Poisoning?

Strychnine poisoning can be diagnosed commonly by consistent signs and analysis of the stomach contents.

Thin-layer chromatography may be done on stomach contents and urine samples. A blood test is not reliable. Other blood tests are done, and these include:

• Basic metabolic panel.

• Arterial or venous blood gas.

• Lactate.

• Urine analysis has to be done.

• Tests are to be done to diagnose hyperkalemia, acidosis, rhabdomyolysis, and renal failure.

What Is the Treatment of Strychnine Poisoning?

Strychnine poisoning or toxicosis is an emergency condition and needs to be addressed immediately. Treatment should be focused on decontamination, control of tremors and seizures, prevention of hypoxia, and supportive care.

1. First and foremost, treatment should involve supportive care that helps secure the airway. Endotracheal intubation may be used to secure the airway.

2. If the treatment is considered in the first few hours, activated charcoal or gastric lavage is used for decontamination.

3. Medications such as benzodiazepines and barbiturates are used to control muscle contractions.

4. If convulsions cannot be controlled and if they cause hyperthermia or acidemia, the affected individual should be intubated and paralyzed with nondepolarizing paralytic agents.

5. Treatment of rhabdomyolysis is done with intravenous fluid hydration.

6. If tubation is necessary, succinylcholine should be avoided.

Recovery is complete in minor to moderate cases. It is not associated with any neurological or musculoskeletal sequelae.

What Are the Prognosis and Outcomes of Strychnine Poisoning?

Prognosis and outcomes of strychnine poisoning are good in case of minor or moderate exposures, and recovery is almost complete without any brain or muscle problems. In severe cases, which involve neurological or muscle damage, recovery takes a longer time, and sometimes it may lead to permanent disability.

When to Consult a Doctor?

Strychnine poisoning is an emergency condition, and its recovery is possible only when the affected person reaches the hospital and takes treatment as early as possible. Hence, consult the doctor and get medical care as early as possible. If the exposure is for a very long duration, then the affected person may lose their life.

Conclusion

Strychnine is considered a strong poison. A small amount of exposure may cause serious health effects. If strychnine poisoning is not treated early or detected, the affected person may die. Hence, it becomes essential to know about it in detail, its mechanism of action, signs and symptoms, and its management. Knowing about strychnine poisoning in detail brings awareness of how to deal with the condition.

Key Takeaway From iCliniq

Strychnine poisoning occurs very rarely. If it happens, it should be dealt with very carefully. The affected person should seek medical care immediately. If not, the person’s death may occur in severe cases. Early identification and quick supportive care may save a life. For more details, you can contact us at icliniq.com.