strychnine and Acidosis

Poppy seed tea is used for its opioid effects and contains multiple opium alkaloids, including morphine, codeine, papaverine, and thebaine. Animal studies indicate thebaine has strychnine-like properties, but there is limited literature describing human thebaine poisoning. We describe a cluster of acute thebaine poisoning in people ingesting tea made using poppy seeds with high thebaine content that entered the Australian food supply chain.. This is an observational study of patients poisoned after drinking poppy seed tea. Cases were identified by three prospective toxicovigilance systems: the Emerging Drug Network of Australia collaboration, the New South Wales Prescription, Recreational and Illicit Substance Evaluation program, and the Emerging Drugs Network of Australia Victoria study. We report characteristics of clinical toxicity in cases with reported ingestion of poppy seed tea and analytical confirmation of thebaine exposure.. Forty cases presenting with multi-system toxicity following poppy seed tea ingestion were identified across seven Australian states/territories from November 2022 to January 2023. Blood testing in 23 cases confirmed high thebaine concentrations. All 23 were male (median age 35, range 16-71 years). All patients experienced muscle spasms. Rigidity was described in nine, convulsions in six, while rhabdomyolysis, acute kidney injury, and metabolic acidosis occurred in five patients. There were two cardiac arrests. The thebaine median admission blood concentration was 1.6 mg/L, with a range of 0.1-5.6 mg/L, and was the dominant opium alkaloid in all samples. Convulsions, acute kidney injury, metabolic acidosis, and cardiac arrest were associated with increasing median thebaine concentrations. Four patients were managed in the Intensive Care Unit, with two receiving continuous kidney replacement therapy (one also received intermittent haemodialysis) for kidney injury. There was one death.. Thebaine toxicity, like strychnine poisoning, resulted in neuromuscular excitation characterized by muscle spasm, rigidity, and convulsions. Severe toxicity, including acute kidney injury, metabolic acidosis, and cardiac arrest, appears dose-dependent.

Topics: Acidosis; Acute Kidney Injury; Adolescent; Adult; Aged; Animals; Codeine; Female; Heart Arrest; Humans; Male; Middle Aged; Morphine; Opium; Papaver; Prospective Studies; Seeds; Seizures; Strychnine; Tea; Thebaine; Victoria; Young Adult

Topics: Acidosis; Adult; Animals; Dogs; Humans; Male; Myoglobinuria; Poisoning; Seizures; Strychnine

Topics: Acidosis; Adult; Critical Care; Female; Humans; Hypoxia; Pregnancy; Pregnancy Complications; Strychnine; Suicide, Attempted

The treatment comprising a special diet (without glycine, serine, and with a reduced amount of threonine), strychnine nitrate and ursodesoxycholic acid (UDCA) led to normoglycinaemia in this form of severe non-ketotic glycine encephalopathy. Diet and treatment were well tolerated but without significant effect upon psychomotor development. This treatment should be more effective if administered before irreversible brain damage occurs, particularly in moderate and chronic forms of NKH.

Topics: Acidosis; Amino Acid Metabolism, Inborn Errors; Child, Preschool; Combined Modality Therapy; Deoxycholic Acid; Female; Food, Formulated; Glycine; Humans; Ketosis; Strychnine; Ursodeoxycholic Acid

Strychnine poisoning results in a predictable and treatable sequence of events involving blockade of the inhibitory neurotransmitter, extensor muscle spasms, seizures, and respiratory paralysis. These spasms may lead to hyperthermia, profound lactic acidosis, and rhabdomyolysis. Acidosis is primarily attributable to lactate, as indicated by the correlation between arterial pH and log of lactic acid concentration (r = -0.878). Interruption of the strychnine blockade is the primary therapy for strychnine poisoning. Phenobarbital in moderate doses should be the first intervention and anesthetic doses should be used if necessary. Suppression of convulsions will permit successful management of the complications of strychnine poisoning. Our patient survived, even though at one point he had a pH of 6.55, a lactate level of 32 mM/liter, a temperature of 43 degrees C, and rhabdomyolysis with an increased creatine phosphokinase level of 359,000 mU/ml (5,983 mumol/s/liter).

Topics: Acidosis; Adult; Body Temperature; Creatine Kinase; Female; Fever; Glycine; Humans; Hydrogen-Ion Concentration; Lactates; Male; Motor Neurons; Myoglobinuria; Phenobarbital; Seizures; Strychnine; Time Factors

Topics: Acidosis; Adult; Diazepam; Female; Humans; Strychnine

Strychnine intoxication is manifested by agitation, muscle spasms, and convulsions. We report a case in which intractable convulsions led to severe lactic acidosis which secondarily resulted in visceral (lung, heart, kidney, liver, and brain) collapse and death. Aggressive therapy instituted in the emergency department and aimed at control of seizure activity and lactic acidosis may be lifesaving.

Topics: Acidosis; Adult; Emergency Service, Hospital; Humans; Male; Muscle Spasticity; Seizures; Strychnine

Topics: Acidosis; Humans; Hydrogen-Ion Concentration; Lactates; Male; Middle Aged; Resuscitation; Strychnine; Suicide, Attempted

Topics: Acidosis; Humans; Strychnine