Dermal exposure to strychnine.

Area of Science:

• Toxicology
• Dermatology

Background:

• Strychnine poisoning is typically associated with ingestion or inhalation.
• Dermal exposure is a less common route but can lead to systemic toxicity.

Observation:

• A 50-year-old woman presented with symptoms consistent with strychnine poisoning 24 hours after dermal exposure to a strychnine spill.
• Clinical signs included lower limb muscle pain, dermal sensitivity, and jaw stiffness.
• Elevated plasma creatine kinase (677 U/L) and serum myoglobin (195 µg/L) suggested rhabdomyolysis.

Findings:

• Strychnine was detected in plasma (196 ng/mL) and urine (6,850 ng/mL) via gas chromatography-mass spectrometry.
• Treatment involved intravenous fluid replacement and alkalinization to prevent renal failure.
• A minor, likely inconsequential, level of pheniramine was also detected.

Implications:

• This case highlights the potential for systemic toxicity from dermal strychnine exposure.
• Early recognition and supportive treatment are crucial for managing non-fatal strychnine poisoning.
• Monitoring for rhabdomyolysis and potential renal complications is important in affected individuals.