Strychnine

Background

Strychnine is a highly toxic substance, mimics generalized tetanus. Antagonizes glycine release, but unlike TS, it has no effect on GABA release.

Clinical Features

• nausea and vomiting
• opisthotonus while Pt. remaining alert
• convulsions
• eventually death through asphyxia

Differential Diagnosis

• generalized tetanus
• Black widow spider bite
• stiff-man syndrome

Jaw Spasms

• Acute tetanus
• Akathisia
• Conversion disorder
• Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
• Dystonic reaction
• Electrolyte abnormality
  • Hypocalcemic tetany
  • Magnesium
• Mandible dislocation
• Meningitis
• Peritonsillar abscess
• Rabies
• Seizure
• Strychnine poisoning
• Stroke
• Temporomandibular disorder
• Torticollis

Workup

serum and urine tests for strychnine

Management

• supportive management
• benzo for seizure

Disposition

• all patients should be admitted

See Also

• Tetanus

Sources

rosen, 7th edition p1684

http://en.wikipedia.org/wiki/Strychnine#Symptoms