Strychnine poisoning

Strychnine poisoning
Classification and external resources
Strychnine
ICD-10	T65.1
ICD-9	989.1

Strychnine poisoning can be fatal to humans and other animals and can occur by inhalation, swallowing or absorption through eyes or mouth. It produces some of the most dramatic and painful symptoms of any known toxic reaction. For this reason, strychnine poisoning is often portrayed in literature and film.

Presentation in humans

Ten to twenty minutes after exposure, the body's muscles begin to spasm, starting with the head and neck in the form of trismus and risus sardonicus. The spasms then spread to every muscle in the body, with nearly continuous convulsions, and get worse at the slightest stimulus. The convulsions progress, increasing in intensity and frequency until the backbone arches continually. Convulsions lead to lactic acidosis, hyperthermia and rhabdomyolysis. These are followed by postictal depression. Death comes from asphyxiation caused by paralysis of the neural pathways that control breathing, or by exhaustion from the convulsions. The subject dies within 2–3 hours after exposure.

One medical student in 1896 described the experience in a letter to the Lancet:

Three years ago I was reading for an examination, and feeling "run down". I took 10 minims of strychnia solution (B.P.) with the same quantity of dilute phosphoric acid well diluted twice a day. On the second day of taking it, towards the evening, I felt a tightness in the "facial muscles " and a peculiar metallic taste in the mouth. There was great uneasiness and restlessness, and I felt a desire to walk about and do something rather than sit still and read. I lay on the bed and the calf muscles began to stiffen and jerk. My toes drew up under my feet, and as I moved or turned my head flashes of light kept darting across my eyes.. I then knew something serious was developing, so I crawled off the bed and scrambled to a case in my room and got out (fortunately) the bromide of potassium and the chloral. I had no confidence or courage to weigh them, so I guessed the quantity-about 30 gr. bromide of potassium and 10 gr. chloral-put them in a tumbler with some water, and drank it off. My whole body was in a cold sweat, with anginous attacks in the precordial region, and a feeling of "going off." I did not call for medical aid, as I thought the symptoms declining. I felt better, but my lower limbs. were as cold as ice and the calf muscles kept tense and, jerking. There was no opisthotonos, only a slight stiffness at the back of the neck. Half an hour later, as I could judge, I took the same quantity of bromide of potassium and chloral, and a little time after I lost consciousness and fell into a " profound sleep," awaking in the morning with no unpleasant symptoms, no headache, &c., but a desire " to be on the move " and a slight feeling of stiffness in the jaw. These worked off during the day.

Treatment

There is no specific antidote for strychnine. Treatment of strychnine poisoning involves an oral application of an activated charcoal infusion which serves to absorb any poison within the digestive tract that has not yet been absorbed into the blood. Anticonvulsants such as phenobarbital or diazepam are administered to control convulsions, along with muscle relaxants such as dantrolene to combat muscle rigidity. If the patient survives past 24 hours, recovery is probable.

The treatment for strychnine poisoning in the late 19th and early 20th centuries was to administer tannic acid which precipitates the strychnine as an insoluble tannate salt, and then to anaesthetise the patient with chloroform until the effects of the strychnine had worn off.

Detection in biological specimens

Strychnine is easily quantitated in body fluids and tissues using instrumental methods in order to confirm a diagnosis of poisoning in hospitalized victims or to assist in the forensic investigation of a case of fatal overdosage. The concentrations in blood or urine of those with symptoms are often in the 1–30 mg/L range.

Strychnine toxicity in animals

Strychnine poisoning in animals occurs usually from ingestion of baits designed for use against rodents (especially gophers and moles) and coyotes. Rodent baits are commonly available over-the-counter, but coyote baits are illegal in the United States. However, since 1990 in the United States most baits containing strychnine have been replaced with zinc phosphide baits. The most common domestic animal to be affected is the dog, either through accidental ingestion or intentional poisoning. An approximate lethal dose for a dog is 0.75 mg per kg body weight.

The onset of symptoms is 10 to 120 minutes after ingestion. Symptoms include seizures, a "sawhorse" stance, and opisthotonus (rigid extension of all four limbs). Death is usually secondary to respiratory paralysis. Treatment is by detoxification using activated charcoal, pentobarbital for the symptoms, and artificial respiration for apnea.

In most western nations a special license is needed to use and possess strychnine for agricultural use.

Notable strychnine poisonings

• Strychnine poisoning (in contaminated wine) is one of the theories concerning the death of Alexander the Great.
• Strychnine was used in several of the murders committed by serial killer Thomas Neill Cream, who poisoned prostitutes on the streets of London.
• Famous Delta Blues legend Robert Johnson's whiskey bottle was allegedly laced with strychnine, resulting in pneumonia.
• A childhood friend of Vincent Van Gogh, Margot Begemann, attempted suicide by ingestion of strychnine.
• Belle Gunness of La Porte, Indiana, also known as Lady Bluebeard, reportedly used strychnine to murder her victims at the turn of the 20th century.
• Hannes Hirtzberger, Mayor of Spitz in Lower Austria was reported to have been poisoned by Helmut Osberger, a local wine producer.
• Jane Stanford, co founder of Stanford University may have died from strychnine poisoning.
• A woman in San Diego, California was a victim of strychnine poisoning in 1990 at the hands of her husband, who had dialed 911 but hung up the telephone without leaving his name or address. Persistence on the part of the dispatcher and the rescue workers allowed them to locate and extract the victim, but she eventually died in the hospital.

Fictional strychnine poisonings

• Mrs. Emily Inglethorp in Agatha Christie's The Mysterious Affair at Styles
• Inmates in the popular TV series The Wire were given heroin doses laced with strychnine.
• Norman Bates' mother and her lover were killed with strychnine in Alfred Hitchcock's Psycho. The sheriff comments: "Ugly way to die."
• Chief Constable Riddle's daughter, Emily was killed with an accidentally lethal case of strychnine-laced cocaine in Peter Robinson's "Cold Is The Grave".
• Herb in Die Softly by Christopher Pike.
• In Cape Fear Max Cady poisons Sam Bowden's dog with strychnine.
• Rio Takeuchi in the manga Spiral: Suiri no Kizuna threatens main character, Ayumu Narumi in a game to test his luck using strychnine poisoning.
• In "All Things Wise and Wonderful", James Herriot, the main character and local veterinarian, deals with several victims of strychnine poisoning when a dog-killer attacks the neighborhood dogs.
• The murder in the Monk episode Mr. Monk and the Secret Santa is carried out through a bottle of port poisoned with strychnine.
• The Joker makes a cameo appearance in the Elseworld graphic novel Gotham by Gaslight as a serial killer who tries to kill himself with strychnine, leaving him with a permanent grin.

External links

• CDC Emergency Preparedness and Response: Facts About Strychnine
• The Merck Veterinary Manual: Strychnine Poisoning: Introduction