Strychnine
Background
- Strychnine is a highly toxic substance, mimics generalized tetanus
- Antagonizes glycine release, but unlike TS, it has no effect on GABA release
- Gopher poison classically
Clinical Features
- Nausea and vomiting
- Opisthotonus while patient remaining alert
- Convulsions
- Eventually death through asphyxia
Differential Diagnosis
- Black widow spider bite
- Stiff-man syndrome
Movement Disorders and Other Abnormal Contractions
- Chorea
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Hypocalcemia
- Strychnine toxicity
- Acute tetanus
- Parkinson's disease
- Mono amine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Anti-NMDA receptor encephalitis
- Huntington disease
- Wilson's disease
- CVA
- Schizophrenia
- Psychotic agitation
- Dementia
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
- Dystonic reaction
- Extrapyramidal reaction
- Torticollis
- Idiopathic movement disorder
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