strychnine and Spasm

A 48-year-old male intentionally ingested "gopher killer" containing strychnine as a, suicide attempt. He rapidly developed generalized muscle spasms with opisthotonos followed by cardiovascular collapse. He was resuscitated, treated with 24 h of, neuromuscular paralysis, and was discharged on hospital day 10 without sequelae. A blood strychnine concentration obtained five hours post ingestion was 2.2 mg/L. Strychnine poisoning is exceedingly rare in the modern United States and this report contains a video recording of the classic exam findings.

Topics: Disease Progression; Humans; Male; Middle Aged; Poisoning; Spasm; Strychnine; Suicide, Attempted; United States

Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe strychnine poisoning from ingestion of a Southeast Asian herbal supplement quantitatively confirmed by serum and urine analysis.. A 40-year-old Cambodian woman presented to the emergency department with a complaint of jaw pain and spasms. The patient was staying with a relative and drank 2 oz from an unmarked bottle that she thought contained vodka. She then developed trismus and abdominal cramping, after which a family member said the bottle contained a compound called "slang nut." Her vital signs were as follows: heart rate 102 beats/min, blood pressure 142/72 mm Hg, respiratory rate 20 breaths/min, and oxygen level 100%. The physical examination revealed no significant abnormalities. Serum toxicologic screens were negative except for strychnine levels that revealed a serum concentration of 350 ng/mL and a urine concentration >200 ng/mL. The patient was observed for 2.5 h and discharged with no long-term complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Strychnine is a well-known compound that has been used in poisons, rodenticides, and performance enhancing drugs for years. In the Western world, strychnine is a much less common poisoning given that its use has been restricted because of the potential for severe toxicity; however, given its potentially high mortality, it is important to be aware of other sources of exposure, including those from herbal and homeopathic remedies.

Topics: Adult; Colic; Dizziness; Female; Headache; Humans; Pain; Phytotherapy; Spasm; Strychnine; Strychnos nux-vomica; Trismus; United States

Topics: Adult; Atropine; Charcoal; Diazepam; Drug Combinations; Gastric Lavage; Humans; Insecticides; Intubation, Gastrointestinal; Male; Midazolam; Poisoning; Poisons; Pralidoxime Compounds; Propoxur; Spasm; Strychnine; Suicide, Attempted

'Maqianzi' (the dried ripe seed of Strychnos nux-vomica L.) contains 1.0-1.4% each of strychnine and brucine. After processing to reduce its toxicity, 'maqianzi' was used as a herbal remedy for rheumatism, musculoskeletal injuries and limb paralysis. A 42-year old woman with neck pain was prescribed 15 g of 'maqianzi' to be taken in two doses at 7 hours apart, although the recommended dose was 0.3-0.6 g. She was apparently well after drinking the first of two bowls of 'maqianzi' decoction. One hour after she drank the second bowl of herbal decoction, she suddenly developed tonic contractions of all her limb muscles and carpopedal spasm lasting 5 min, difficulty in breathing, chest discomfort and perioral numbness. The second bowl of decoction probably became more concentrated because of evaporation of water during continued boiling and contained a larger amount of 'maqianzi'. On arrival in the hospital 1 hour later, she complained of muscle pain and tiredness. She was found to have hyperventilation and weakness of four limbs, with muscle power of grade 5(-)/5. All her symptoms gradually subsided over the next few hours. This case illustrated that 'maqianzi' can cause strychnine poisoning even after processing, especially when the recommended dose is greatly exceeded. In any patient with 'unexplained' muscle spasms or convulsions, strychnine poisoning should be included in the differential diagnosis and they should be asked about the use of herbal medicines.

Topics: Administration, Oral; Adult; Female; Herbal Medicine; Humans; Hyperventilation; Neck Pain; Phytotherapy; Plant Preparations; Poisoning; Poisons; Spasm; Strychnine; Strychnos

The inhibitory glycine receptor of mammalian spinal cord is a ligand-gated chloride channel that, on affinity purification, contains two subunits of 48-kilodalton (kD) and 58-kD molecular mass in addition to an associated 93-kD protein. Ligand-binding 48-kD subunit and 93-kD protein were quantified in the CNS of the adult rat using a newly developed dot receptor assay (detection limit less than or equal to 1 fmol/assay) which employs monoclonal antibodies specific for glycine receptor polypeptides. The 93-kD protein was found to codistribute at a fixed stoichiometry with the 48-kD subunit throughout the CNS of the rat. Moreover, the 93-kD protein cofractionated with the ligand-binding subunit on solubilization and affinity chromatography or immunoprecipitation. However, both proteins were separated on sucrose gradient centrifugation of detergent extracts of spinal cord membranes in accord with earlier observations on purified receptor. These data prove that the 93-kD polypeptide is selectively associated with the membrane core of the strychnine-sensitive glycine receptor. The regional distribution of glycine receptor polypeptides was also determined in the CNS of the spastic rat mutant. In contrast to hereditary spasticity in mouse and cattle, no reduction of glycine receptors was found in the spastic rat.

Topics: Animals; Central Nervous System; Centrifugation, Density Gradient; Chemical Fractionation; Chromatography, Affinity; Epitopes; Immunoassay; Membrane Proteins; Precipitin Tests; Rats; Rats, Inbred Strains; Rats, Mutant Strains; Receptors, Glycine; Receptors, Neurotransmitter; Reference Values; Sensitivity and Specificity; Spasm; Strychnine; Tritium

There is a marked deficit in the binding of the glycine receptor antagonist strychnine to the CNS of the mutant mouse spastic. The characteristics and pharmacology of [3H]strychnine binding to washed homogenates of spastic and littermate control spinal cord and brainstem were investigated to determine the nature of this defect. The maximal binding of [3H]strychnine to spastic homogenates is approximately 20% the value obtained from littermate control homogenates; the affinity of [3H]strychnine binding is approximately 25% lower than littermate control values. The pharmacology of [3H]strychnine binding has the same rank order of potency in spastic and littermate control mice; however, there are small differences in the potency of several compounds in spastic vs littermate control animals. These results indicate that the glycine receptor alteration seen in the spastic mutant mouse is primarily due to a decrease in receptor number. They also suggest that the pharmacological characteristics of the glycine receptor in spastic are different from littermate control. The data do not permit a distinction between whether the strychnine binding sites found in spastic represent the same population seen in littermate control animals or are a subpopulation that is spared by the mutation.

Topics: Animals; Binding, Competitive; Brain Stem; In Vitro Techniques; Mice; Mice, Neurologic Mutants; Molecular Conformation; Receptors, Glycine; Receptors, Neurotransmitter; Spasm; Spinal Cord; Strychnine

Topics: Child; Humans; Male; Spasm; Strychnine; Tetanus

Topics: Aminobutyrates; Animals; Cats; Decerebrate State; Glycine; Humans; Motor Neurons; Muscle Spasticity; Muscle Spindles; Neural Conduction; Neurons, Afferent; Reflex; Spasm; Spinal Cord; Strychnine

Topics: Animals; Anticonvulsants; Cats; Chlorzoxazone; Interneurons; Mice; Motor Activity; Muscle Contraction; Muscle Relaxants, Central; Muscles; Nicotine; Oxadiazoles; Rats; Reflex; Spasm; Strychnine; Synaptic Transmission

Topics: Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Alcoholic Intoxication; Animals; Anticonvulsants; Blood Pressure; Body Temperature; Bronchi; Catatonia; Dibenzocycloheptenes; Drug Antagonism; Drug Synergism; Electroshock; Gastrointestinal Motility; Heart; Histamine H1 Antagonists; Humans; Knee; Male; Methionine Sulfoximine; Mice; Motor Activity; Nervous System; Neuromuscular Junction; Pentylenetetrazole; Reaction Time; Reflex; Reticular Formation; Spasm; Strychnine; Tremor

Topics: Adolescent; Antidotes; Chemistry, Clinical; Chromatography, Paper; Diazepam; Diuresis; Female; Humans; Oxides; Poisoning; Spasm; Spectrophotometry; Strychnine; Tablets

Topics: Animals; Microscopy, Electron; Motor Neurons; Rats; Spasm; Spinal Cord; Strychnine; Tetanus; Tetanus Toxin