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Published on: January 18, 2013
[Strychnine poisoning]
N Scheffold1, B Heinz, H Albrecht
1Medizinische Klinik I , Schwerpunkt Kardiologie. Norbert.Scheffold@Klinikum-Heilbronn.de
History And Admission Findings:
A 46-year-old man presented two hours after ingestion of about 250 mg strychnine with severe violent, generalized convulsions, triggered by external stimuli. During the convulsion-free periods there were no abnormal signs in the physical examination.
Investigation:
The presence of strychnine was confirmed by urine analysis with gas chromatography-mass spectrometry.
Treatment And Course:
Because diazepam as anticonvulsant of choice was not effective in abating the convulsions the patient was intubated. A combination with midazolam, fentanyl and pancuronium was effective in controlling the convulsions. The patient was discharged from ICU on day three.
Conclusion:
Fatal outcome of strychnine poisoning demands an aggressive management with early intubation, control of muscle tremors and prevention of rhabdomyolisis and renal failure.
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