Dermal exposure to strychnine

A non-fatal case of strychnine poisoning through dermal exposure is described. About 24 h after cleaning up a strychnine spill, a 50-year-old woman presented to the emergency department with classical signs of strychnine poisoning, consisting of marked pain in the muscles of her lower limbs, dermal sensitivity, and stiffness in her jaw. Her treatment was intravenous fluid replacement and alkalinization in anticipation of potential renal failure due to rhabdomyolysis. Her plasma creatine kinase was elevated to 677 U/L with no rise in the heart specific MB fraction. Serum myoglobin level obtained retrospectively was 195 microg/L. Biological samples were taken approximately 28 h after her exposure. Strychnine was measured in plasma (196 ng/mL) and urine (6,850 ng/mL) by gas chromatography-mass spectrometry. The small amount of pheniramine in the plasma (35 ng/mL) and urine (1,255 ng/mL) is considered an inconsequential finding.