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Strychnine
From WikEM
Contents
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
- Dystonic reaction
- Acute tetanus
- Conversion disorder
- Mandibular dislocation
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Meningitis
- Seizure disorder
- Strychnine poisoning
- Akathisia
- Stroke
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Torticollis
- PTA
- Rabies
- TMJ
Evaluation
- Serum and urine tests for strychnine
Management
- Supportive management
- Benzodiazepines for seizure
Disposition
- All patients should be admitted
