Strychnine poisoning in an adolescent

One half hour following the ingestion of a possibly tainted antibiotic capsule, a 14 year-old female experienced acute onset of stiffness and weakness in her lower extremities. She subsequently survived despite the development of convulsions, severe lactic acidosis (pH 6.86), hyperthermia (Temp 40.5 degrees C) and rhabdomyolysis. Toxicology testing confirmed the presence of strychnine in blood, gastric aspirate, and urine. Her course, history and outcome are presented and the pharmacokinetics, the mechanism of action, signs and symptoms and treatment of strychnine poisoning are reviewed.