[Strychnine poisoning].
METHODS
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.


METHODS
The presence of strychnine was confirmed by urine analysis with gas chromatography-mass spectrometry.


METHODS
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.


CONCLUSIONS
Fatal outcome of strychnine poisoning demands an aggressive management with early intubation, control of muscle tremors and prevention of rhabdomyolisis and renal failure.
Medizinische Klinik I , Schwerpunkt Kardiologie. Norbert.Scheffold@Klinikum-Heilbronn.de
N
N
Scheffold
B
B
Heinz
H
H
Albrecht
A
A
Pickert
J
J
Cyran
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002849:Chromatography, Gas; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010197:Pancuronium / Q000008:administration & dosage / Q000627:therapeutic use; D011041:Poisoning / Q000175:diagnosis / Q000188:drug therapy; D013331:Strychnine / Q000506:poisoning* / Q000652:urine; D013406:Suicide, Attempted; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D003473:Neuromuscular Nondepolarizing Agents; D013331:Strychnine; D010197:Pancuronium; D008874:Midazolam; D005283:Fentanyl