title: Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data.
abstract: BACKGROUND
  Strychnine poisoning is uncommon, and in most severe cases, the patient dies before reaching hospital. The management of strychnine poisoning is well documented, although there are few data on the kinetics of elimination of strychnine after overdose.
  
  
  METHODS
  A 42-year-old man presented shortly after ingestion of an unknown quantity of strychnine powder. After a respiratory arrest, with intensive supportive management requiring admission to an intensive care unit, he survived. Eight serum samples were taken over the first 5 days and analysed subsequently for strychnine concentrations.
  
  
  RESULTS
  The initial concentration at 1.5 hours after ingestion was 4.73 mg/l, falling to 0.38 mg/l at 74 hours postingestion. Serum concentrations followed a monoexponential elimination curve with a calculated elimination half-life of 12 hours.
  
  
  CONCLUSIONS
  Strychnine poisoning presents with classical features, and with early diagnosis and supportive management, the patient can survive. The initial serum concentration of 4.73 mg/l is the highest reported concentration in a patient who has survived. Previous reports of the elimination half-life have suggested it is between 10 and 16 hours, which conforms to the elimination data in our case.
authors.affiliation: National Poisons Information Service, Guy's and St Thomas' Hospital, London, UK. grex1@hotmail.com
authors.forename: David
authors.initials: D
authors.lastname: Wood
authors.forename: Emma
authors.initials: E
authors.lastname: Webster
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez
authors.forename: Paul
authors.initials: P
authors.lastname: Dargan
authors.forename: Alison
authors.initials: A
authors.lastname: Jones
mesh_terms: D000328:Adult; D003422:Critical Care; D006207:Half-Life; D006801:Humans; D008297:Male; D011041:Poisoning / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013331:Strychnine / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D013331:Strychnine