Strychnine poisoning

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Strychnine poisoning
Strychnine2.svg
Strychnine
Specialty Emergency medicine   OOjs UI icon edit-ltr-progressive.svg
Complications Lactic acidosis, Hyperthermia, Rhabdomyolysis
Usual onset10–20 minutes after exposure
CausesExposure to strychnine
Diagnostic method 1–30 mg/L strychnine in blood
Medication Anticonvulsants

Strychnine poisoning is poisoning induced by strychnine. It can be fatal to humans and other animals and can occur by inhalation, swallowing or absorption through eyes or mouth. It produces some of the most dramatic and painful symptoms of any known toxic reaction, making it quite noticeable and a common choice for assassinations and poison attacks. For this reason, strychnine poisoning is often portrayed in literature and film, such as the murder mysteries written by Agatha Christie. [1]

Contents

The probable lethal oral dose in humans is 1.5 to 2 mg/kg. [2] Similarly, the median lethal dose for dogs, cats, and rats ranges from 0.5 to 2.35 mg/kg. [3]

Presentation in humans

Ten to twenty minutes after exposure, the body's muscles begin to spasm, starting with the head and neck in the form of trismus and risus sardonicus. The spasms then spread to every muscle in the body, with nearly continuous convulsions, and get worse at the slightest stimulus. The convulsions progress, increasing in intensity and frequency until the backbone arches continually. Convulsions lead to lactic acidosis, hyperthermia and rhabdomyolysis. These are followed by postictal depression. Death comes from asphyxiation caused by paralysis of the neural pathways that control breathing, or by exhaustion from the convulsions. The subject usually dies within two to three hours after exposure.

One medical student in 1896 described the experience in a letter to The Lancet :

Three years ago I was reading for an examination, and feeling "run down". I took 10 minims of strychnia solution (B.P.) with the same quantity of dilute phosphoric acid well diluted twice a day. On the second day of taking it, towards the evening, I felt a tightness in the "facial muscles" and a peculiar metallic taste in the mouth. There was great uneasiness and restlessness, and I felt a desire to walk about and do something rather than sit still and read. I lay on the bed and the calf muscles began to stiffen and jerk. My toes drew up under my feet, and as I moved or turned my head flashes of light kept darting across my eyes. I then knew something serious was developing, so I crawled off the bed and scrambled to a case in my room and got out (fortunately) the bromide of potassium and the chloral. I had no confidence or courage to weigh them, so I guessed the quantity—about 30 gr. [30 grains, about 2 grams] bromide of potassium and 10 gr. chloral—put them in a tumbler with some water, and drank it off. My whole body was in a cold sweat, with anginous attacks in the precordial region, and a feeling of "going off." I did not call for medical aid, as I thought that the symptoms were declining. I felt better, but my lower limbs were as cold as ice, and the calf muscles kept tense and were jerking. There was no opisthotonos, only a slight stiffness at the back of the neck. Half an hour later, as I could judge, I took the same quantity of bromide, potassium and chloral—and a little time after I lost consciousness and fell into a "profound sleep," awaking in the morning with no unpleasant symptoms, no headache, &c., but a desire "to be on the move" and a slight feeling of stiffness in the jaw. These worked off during the day. [4]

Treatment

There is no antidote for strychnine poisoning. [5] Strychnine poisoning demands aggressive management with early control of muscle spasms, intubation for loss of airway control, toxin removal (decontamination), intravenous hydration and potentially active cooling efforts in the context of hyperthermia as well as hemodialysis in kidney failure (strychnine has not been shown to be removed by hemodialysis). [6] Treatment involves oral administration of activated charcoal, which adsorbs strychnine within the digestive tract; unabsorbed strychnine is removed from the stomach by gastric lavage, along with tannic acid or potassium permanganate solutions to oxidize strychnine. [7]

Activated charcoal

Activated charcoal is a substance that can bind to certain toxins in the digestive tract and prevent their absorption into the bloodstream. [8] The effectiveness of this treatment, as well as how long it is effective after ingestion, are subject to debate. [9] [10] [11] According to one source, activated charcoal is only effective within one hour of poison being ingested, although the source does not regard strychnine specifically. [12] Other sources specific to strychnine state that activated charcoal may be used after one hour of ingestion, depending on dose and type of strychnine-containing product. [13] [10] Therefore, other treatment options are generally favoured over activated charcoal. [10] [14]

The use of activated charcoal is considered dangerous in patients with tenuous airways or altered mental states. [15]

Other treatments

Most other treatment options focus on controlling the convulsions that arise from strychnine poisoning. These treatments involve keeping the patient in a quiet and darkened room, [16] anticonvulsants such as phenobarbital or diazepam, [6] muscle relaxants such as dantrolene, [17] barbiturates and propofol, [18] and chloroform or heavy doses of chloral, bromide, urethane or amyl nitrite. [19] [20] [21] [22] If a poisoned person is able to survive for 6 to 12 hours subsequent to initial dose, they have a good prognosis. [6]

The sine qua non of strychnine toxicity is the "awake" seizure, in which tonic-clonic activity occurs but the patient is alert and oriented throughout and afterwards. [23] Accordingly, George Harley (1829–1896) showed in 1850 that curare (wourali) was effective for the treatment of tetanus and strychnine poisoning.

Detection in biological specimens

Strychnine is easily quantitated in body fluids and tissues using instrumental methods in order to confirm a diagnosis of poisoning in hospitalized victims or to assist in the forensic investigation of a case of fatal overdosage. The concentrations in blood or urine of those with symptoms are often in the 1–30 mg/L range. [24]

Strychnine toxicity in animals

Strychnine poisoning in animals occurs usually from ingestion of baits designed for use against rodents (especially gophers and moles) and coyotes. Rodent baits are commonly available over-the-counter, but coyote baits are illegal in the United States. However, since 1990 in the United States most baits containing strychnine have been replaced with zinc phosphide baits. [25] The most common domestic animal to be affected is the dog, either through accidental ingestion or intentional poisoning. The onset of symptoms is 10 to 120 minutes after ingestion. [26] Symptoms include seizures, a "sawhorse" stance, and opisthotonus (rigid extension of all four limbs). Death is usually secondary to respiratory paralysis. Treatment is by detoxification using activated charcoal, pentobarbital for the symptoms, and artificial respiration for apnea.

In most western nations a special license is needed to use and possess strychnine for agricultural use.

Notable instances

The most notable incidents which probably involved strychnine poisoning, are listed here.

In culture

Strychnine has also served as an inspiration in several books, movies and TV series.

In literature

In film

In television

In music

References

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  2. E., Gosselin, Robert (1984). Clinical toxicology of commercial products. Williams & Wilkins. ISBN   0-683-03632-7. OCLC   252306964.{{cite book}}: CS1 maint: multiple names: authors list (link)
  3. "CDC - Immediately Dangerous to Life or Health Concentrations (IDLH): Strychnine - NIOSH Publications and Products". www.cdc.gov. 2018-11-02. Retrieved 2022-02-19.
  4. Sandall, Leondard, (28 March 1896). "An Overdose of Strychnine". The Lancet, 147(3787):887.
  5. "Strychnine: Biotoxin | NIOSH | CDC". www.cdc.gov. 2023-05-26. Retrieved 2024-08-12.
  6. 1 2 3 "CDC – The Emergency Response Safety and Health Database: Biotoxin: Strychnine – NIOSH". www.cdc.gov. Archived from the original on 2015-12-21. Retrieved 2016-01-02.
  7. Patocka, Jiri (December 2015). Gupta, Ramesh C. (ed.). "Strychnine". Handbook of Toxicology of Chemical Warfare Agents (2nd ed.). Elsevier Inc.: 215–222. doi:10.1016/B978-0-12-800159-2.00017-8. ISBN   978-0-12-800159-2 via ResearchGate.
  8. "Charcoal, Activated (Oral Route) Proper Use - Mayo Clinic". Mayo Clinic . Archived from the original on 2024-02-06. Retrieved 2024-02-06.
  9. Shadnia S, Moiensadat M, Abdollahi M (April 2004). "A case of acute strychnine poisoning". Veterinary and Human Toxicology. 46 (2): 76–9. PMID   15080207. S2CID   23272093.
  10. 1 2 3 Otter J, D'Orazio JL (August 7, 2023). Strychnine Toxicity. StatPearls. PMID   29083795. NCBI   NBK459306.
  11. Cooney DO (August 1995). "Evaluation of the US pharmacopeia adsorption tests for activated charcoals and proposals for changes". Veterinary and Human Toxicology. 37 (4): 371–7. PMID   8540235. S2CID   67975596.
  12. Lapus, Robert Michael (April 2007). "Activated charcoal for pediatric poisonings: the universal antidote?" (PDF). Current Opinion in Pediatrics. 19 (2): 216–222. doi:10.1097/MOP.0b013e32801da2a9. PMID   17496769. S2CID   6728477. Archived (PDF) from the original on 2024-02-06. Retrieved 2024-02-06.
  13. Hayden JW, Comstock EG (1975). "Use of Activated Charcoal in Acute Poisoning" . Clinical Toxicology. 8 (5): 515–533. doi:10.3109/15563657508988096. PMID   770060. S2CID   42542989. Archived from the original on 2024-03-08. Retrieved 2024-02-06.
  14. "CDC Strychnine | Facts about Strychnine | Public Health Emergency Preparedness& Response". 16 January 2020. Archived from the original on 6 February 2024. Retrieved 6 February 2024.
  15. Smith BA (1990). "Strychnine poisoning". The Journal of Emergency Medicine. 8 (3): 321–325. doi:10.1016/0736-4679(90)90013-L. PMID   2197324.
  16. "Drugs and Poisons Fact Sheet: Strychnine Permits - What you need to know". Queensland Health. Retrieved 12 August 2024.
  17. "Final Diagnosis -- Case 550". path.upmc.edu. Retrieved 2024-08-12.
  18. Lages A, Pinho J, Alves R, Capela C, Lourenço E, Lencastre L (16 May 2013). "Strychnine Intoxication: A Case Report". Journal of Medical Cases. 4 (6): 385–388. doi: 10.4021/jmc1189w . S2CID   54707248.
  19. Cushny AR (January 1, 1940). Pharmacology and Therapeutics (12 ed.). Lea & Febiger. ASIN   B000SNDA1U.
  20. Buckley S (September 1873). "Case of Strychnine Poisoning Successfully Treated by Atropine". Edinburgh Medical Journal. 19 (3): 211–213. PMC   5315983 . PMID   29640880. S2CID   4760315.
  21. "The Treatment of Strychnine Poisoning" . Journal of the American Medical Association. 98 (23): 1992. 1932. doi:10.1001/jama.1932.02730490038013. Archived from the original on 2024-02-06. Retrieved 2024-02-06.
  22. "Strychnine and Vomit: The Untold Story of Past US Addiction Treatments". 8 September 2021. Archived from the original on 6 February 2024. Retrieved 6 February 2024.
  23. Boyd RE, Brennan PT, Deng JF, Rochester DF, Spyker DA (March 1983). "Strychnine poisoning. Recovery from profound lactic acidosis, hyperthermia, and rhabdomyolysis". The American Journal of Medicine. 74 (3): 507–512. doi:10.1016/0002-9343(83)90999-3. PMID   6829597. S2CID   3222667.
  24. R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1448–1450.
  25. Ettinger, Stephen J.; Feldman, Edward C. (1995), Textbook of Veterinary Internal Medicine (4th ed.), W.B. Saunders Company, ISBN   0-7216-6795-3
  26. Beasley, V. (1999). "Toxicants Associated with Seizures". Veterinary Toxicology. Retrieved 2006-06-18.
  27. Graham Phillips (2004). Alexander the Great. Murder in Babylon. Virgin Books, 2004. p. 239ff. ISBN   1-85227-134-5.
  28. "Christiana Edmunds". Old Police Cells Museum. Retrieved 29 July 2020.
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  30. Kridel, Kristen (February 12, 2008), "A century-old mystery: Did serial killer fake her death?", Chicago Tribune
  31. Cutler, Robert (2003), The Mysterious Death of Jane Stanford, Stanford University Press, ISBN   0-8047-4793-8
  32. "Nishimura Mystery Still Unsolved". The Straits Times. 15 December 1934.
  33. "Allegations of Spying?". The Straits Times. 9 December 1934.
  34. Ruder, Stephen (29 April 2019). "Espionage Double Cross in Singapore". Warfare History Network. Retrieved 2019-06-02.
  35. Graves, Tom; LaVere, Steve (2008). Crossroads: The Life and Afterlife of Blues Legend Robert Johnson . Demers Books LLC. pp.  39–43. ISBN   978-0-9816002-0-8. The tale most often told about how Johnson met his fate is that he was poisoned by a jealous husband who put strychnine in his whiskey.
  36. Death certificate for Irene Margaret Bates. Registration district: 3318. Certificate number: 2234. Recorded July 8, 1969. Riverside City, Riverside County.
  37. "Turkish ex-president's autopsy fuels poisoning speculation". Chicago Tribune. 4 November 2012.
  38. "Late Turkish President Turgut Özal : Had he been poisoned indeed ? Confusing reports from forensics – NationalTurk". 2 November 2012.
  39. Anderson, L. V. (5 November 2012). "These Old Bones". Slate.
  40. Today's Zaman, 20 June 2013, Independent expert evaluation casts doubt on Özal report Archived 2016-03-05 at the Wayback Machine
  41. Rogers, David (February 28, 2008), "Suspect in poisoned-mayor case has been arrested", Wiener Zeitung , archived from the original on March 19, 2008
  42. Bloch, Robert (1959). Psycho (2010 ed.). United States: The Overlook Press. pp. 169, 173. ISBN   978-1-59020-335-4.{{cite book}}: ISBN / Date incompatibility (help)
  43. "The Poison That Killed A Major Game Of Thrones Character Is Real". Business Insider .