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 patient 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

Evaluation

• Serum and urine tests for strychnine

Management

• Supportive management
• Benzodiazepines for seizure

Disposition

• All patients should be admitted

See Also

• Tetanus