II. Background
- Strychnine tree (Strychnos nux vomica) is a tree native to Southwest Asia and Northern Australia
- Strychnine seeds contain an alkaloid toxin used to kill rodents
- Strychnine is also found in some products consumed by humans
- Ma Qian Zi (Chinese herbal)
- Salang Chai Nut (Cambodian herbal)
- Contaminant in production of street drugs (e.g. Cocaine, Amphetamine or Heroin)
- Historically used in BarbiturateOverdose
III. Pharmacokinetics
- Lethal dose 1-2 mg/kg (or 50-100 mg)
- Onset of activity: <15 to 60 minutes from ingestion
- Elimination half life: 10-16 hours
- Volume of distribution (large): 13 L/kg
IV. Mechanism
- Strychnine competitively blocks Glycine
-
Glycine is an inhibitory Neurotransmitter
- Results in Neuronal disinhibition and increased excitability (esp. in spinal column)
V. Signs
- Constitutional
- Agitation
- Anxiety
- Neuromuscular (primary effects, Tetanus-like reaction)
- Painful, severe Muscle spasms, rigidity, cramps with minimal triggers
- Hypersensitivity to external stimuli
- Nystagmus
- Dysphagia
- Opisthotonos (arched back)
- Risus Sardonicus (Sardonic Grinning)
- Trismus (lock jaw)
- Cardiopulmonary
- Tachypnea (may progress to apnea)
VI. Labs
- Serum Electrolytes (including Serum Potassium)
- Renal Function tests
- Creatinine phosphokinase
VII. Differential Diagnosis
- See Tetanus
VIII. Management
- ABC Management with Endotracheal Intubation as needed
- Gastrointestinal Decontamination with Activated Charcoal
- Indicated if ingestion within prior 1 hour
- Decrease Muscle Contractions, hyperthermia
- Reduce patient movement, stimulation
- Benzodiazepines
- Consider intubation, sedation and paralysis
IX. Complications
X. References
- Otter and Tomaszewski (2019) Crit Dec Emerg Med 33(3): 28
- Leikin (1996) Poisoning and Toxicology, Lexi-comp, p.1016-7
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Definition (MSH) | An alkaloid found in the seeds of STRYCHNOS NUX-VOMICA. It is a competitive antagonist at glycine receptors and thus a convulsant. It has been used as an analeptic, in the treatment of nonketotic hyperglycinemia and sleep apnea, and as a rat poison. |
Definition (CSP) | extremely poisonous alkaloid which causes excitation of the central nervous system by blocking postsynaptic inhibition of neural impulses. |
Concepts | Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131) , Organic Chemical (T109) |
MSH | D013331 |
SnomedCT | 51200005, 354051007 |
LNC | LP14284-1, MTHU004642 |
English | Strychnine, Strychnidin-10-one, Strychnine [Chemical/Ingredient], strychnine, STRYCHNINE, Strychnine (substance), Strychnine product (product), Strychnine product, Strychnine product (substance) |
Swedish | Stryknin |
Spanish | estricnina, producto, estricnina (producto), producto con estricnina (producto), producto con estricnina, estricnina (sustancia), estricnina, producto (sustancia), estricnina, estricnina, producto (producto), Estricnina |
Czech | strychnin |
Finnish | Strykniini |
Russian | BRUTSIN, STRIKHNIN, DIMETOKSISTRIKHNIN, NUX-VOMICA, БРУЦИН, ДИМЕТОКСИСТРИХНИН, СТРИХНИН |
Japanese | ストリキニン, ストリキニーネ, 硝酸ストリキニーネ |
Polish | Nasiona kulczyby, Strychnina |
French | Strychnine |
German | Strychnin |
Italian | Stricnina |
Portuguese | Estricnina |
Ontology: Toxic effect of strychnine (C0274892)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 157709000, 45519004 |
English | Strychnine causing toxic effect, Strychnine causng toxic effect, strychnine toxicity, strychnine toxicity (diagnosis), toxicity from strychnine, strychnine poisoning, Strychnine causing toxic effect (disorder), Strychnine intoxication, Strychnine poisoning, Strychnine toxicity, Toxic effect of strychnine (disorder), Toxic effect of strychnine, Toxic effect of strychnine, NOS |
Spanish | efecto tóxico de la estricnina (trastorno), efecto tóxico de la estricnina, intoxicación por estricnina, toxicidad por estricnina |