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Herbal medicine causing likely strychnine poisoning.
1Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories. tykchan@cuhk.edu.hk
Human & Experimental Toxicology
|November 5, 2002
Summary
Maqianzi, a traditional herbal remedy, can cause severe strychnine poisoning if the dose is greatly exceeded, even after processing. This case highlights the importance of correct dosage in herbal medicine to prevent adverse effects.
Area of Science:
- Toxicology
- Pharmacology
- Ethnomedicine
Background:
- Maqianzi (Strychnos nux-vomica L. seeds) contains toxic alkaloids like strychnine and brucine.
- Processed Maqianzi is traditionally used for musculoskeletal conditions.
- Recommended dosage for Maqianzi is 0.3-0.6 g.
Observation:
- A patient presented with neck pain and was prescribed 15 g of Maqianzi, significantly exceeding the recommended dose.
- After consuming the second dose, the patient experienced severe symptoms including tonic muscle contractions, carpopedal spasm, breathing difficulty, and numbness.
- Hospitalization revealed hyperventilation and muscle weakness, with symptoms gradually resolving over hours.
Findings:
- The case demonstrates that exceeding the recommended dose of Maqianzi can lead to acute strychnine poisoning.
- Concentration of the herbal decoction due to prolonged boiling may have contributed to the overdose.
- Strychnine poisoning should be considered in cases of unexplained muscle spasms or convulsions.
Implications:
- Emphasizes the critical importance of adhering to correct dosages for herbal remedies, even those that have undergone processing.
- Highlights the potential dangers of Maqianzi and the need for cautious use in traditional medicine.
- Stresses the necessity of including herbal medicine use in the differential diagnosis for neurological and muscular emergencies.