Massive strychnine intoxication: Serial blood levels in a fatal case

Abstract

A fatal case of strychnine intoxication is reported. The patient expired despite early aggressive management and prevention of metabolic complications. Serial blood levels are reported. In contrast to a previous report describing first order elimination kinetics, our data suggest that strychnine follows Michaelis-Menton elimination kinetics. The case illustrates the rapid, dramatic course of severe strychnine ingestions. A review of the toxicokinetics, mechanism of action and treatment of strychnine intoxication follows.

Application of solid phase microextraction to the determination of strychnine in blood

“…Strychnine is rapidly absorbed from the gastrointestinal tract. There is very little protein binding [4], and its distribution to tissues is rapid. The major route for removal and detoxification is hepatic metabolism [5], via enzymatic degradation involving the liver microsomal system, and up to 20% of the drug can be excreted unchanged in the urine [4].…”

“…There is very little protein binding [4], and its distribution to tissues is rapid. The major route for removal and detoxification is hepatic metabolism [5], via enzymatic degradation involving the liver microsomal system, and up to 20% of the drug can be excreted unchanged in the urine [4]. Soon after ingestion, violent and generalized convulsions take place, and when death occurs, it is commonly due to asphyxia from respiratory arrest during convulsions [6].…”

Intoxication par la strychnine en 2011 : une menace toujours présente !

“…Les strychninémies mesurées chez notre patient sont à interpréter en fonction du seuil de 0,8 mg/l à la huitième heure considérée comme létale dans la littérature [6,11,16]. Cette donnée est néanmoins à pondérer par la persistance de clonies pour des concentrations bien inférieures à celles que l'on aurait pu attendre au vu de la sévérité clinique de notre patient (0,02 mg/l à j2) ; ce qui d'ailleurs écarte l'hypothèse d'un défaut d'élimination causée par l'insuffisance hépa-tique ischémique et l'insuffisance rénale aiguë et constitue un argument de plus à ajouter à la polémique de l'effet dosedépendant de la strychnine.…”

Ultra-performance liquid chromatography–tandem mass spectrometric method for the determination of strychnine and brucine in mice plasma

“…While in toxicokinetics researches, the concentration of strychnine and brucine will be higher in biofluids than in the mice plasma. In previous reports, concentrations for Str of 2100 ng/ml at 3 h [20] and 3800 ng/ml at 0.5 h [21] in patient's serum caused death. The concentration was still 380 ng/ml post ingestion of Str for 74 h [4].…”