- Kavita M Babu, MD
Kavita M Babu, MD
- Associate Professor of Emergency Medicine
- University of Massachusetts Medical School
Strychnine, an alkaloid derived from seeds of the tree Strychnos nux vomica, was first used as a rodenticide in Germany in the early 16th century. By the early 1900s, strychnine became widely available in cathartic pills, and caused a significant number of fatalities from suicidal and unintentional ingestions in the United States. In the early 1900s, strychnine toxicity was a major cause of toxicologic death in children [1,2]. The number of strychnine exposures in the United States has fallen significantly since its elimination from nonprescription preparations in 1962 .
Although rare, most strychnine poisonings today result from the adulteration of street drugs (eg, cocaine, heroin), as well as from small amounts found in herbal medications and homeopathic remedies . Rarely, cases of poisoning occur in which a strychnine-containing rodenticide is implicated [4-6].
This topic review will discuss the basic pharmacology, clinical presentation, and management of strychnine poisoning. Discussions of the general approach to the management of poisoned patients and detailed management of other toxins are found elsewhere. (See "General approach to drug poisoning in adults".)
PHARMACOLOGY AND CELLULAR TOXICOLOGY
The seeds of Strychnos nux vomica contain 1.1 to 1.4 percent of strychnine and brucine, another toxic alkaloid . Commercial rodenticide preparations typically contain between 0.3 to 5.0 percent strychnine [2,8]. Strychnine is typically formulated as a relatively odorless and tasteless white powder . While brucine (2,3-dimethoxystrychnine) is the lesser alkaloid, lethal ingestion of brucine alone has been reported .
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- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES OF OVERDOSE
- Presentation and physical examination
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- Initial stabilization
- Control of muscle activity
- Airway management and paralysis
- IV fluid, activated charcoal, and other interventions
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS