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అందరికి ప్రవేశం

నైరూప్య

The Dose Makes the Poison: A Case Report on Strychnine Toxicity

Indu M Bindu, RS Tonk

Background: Strychnos nux vomica is a member of Loganiaceae family. It has highly poisonous alkaloids strychnine and brucine, mostly in seeds. It has been used as rodenticides and to kill stray dogs. Homicidal and suicidal cases have also been reported. The use of strychnine is regulated in many countries. However, it is used in indigenous system as treatment for many conditions. But, these have no medical evidence.

Case report: We report the case of a 66 years old lady who presented with episodic spasms after consumption of water in which, this plant stem was soaked overnight. She had tautness of her muscles, multiple episodes each lasting for about 5 to 10 seconds. In between spasms, clinical examination findings were normal. All her blood investigations were normal except for slightly elevated muscle enzymes.

The history of plant product consumption and episodic spasms with intact consciousness made us think of strychnine poisoning. But, no toxicologic tests for the same were available. Hence we proceeded with the toxicologic analysis for alkaloids in the plant stem. The presence of natural alkaloids like strychnine and brucine were confirmed by chemical extraction techniques. She was managed conservatively with diazepam, IV fluids and other supportive care. She recovered completely and was discharged in stable condition.

Conclusion: Ingestion of strychnine (especially fruits, seeds) can cause uncontrolled muscular contractions. The consequences following such uncontrolled seizures is life threatening. Lethality depends on the dose. There is no antidote for strychnine and supportive care is the mainstay of treatment.