Herbal medicine causing likely strychnine poisoning.

'Maqianzi' (the dried ripe seed of Strychnos nux-vomica L.) contains 1.0-1.4% each of strychnine and brucine. After processing to reduce its toxicity, 'maqianzi' was used as a herbal remedy for rheumatism, musculoskeletal injuries and limb paralysis. A 42-year old woman with neck pain was prescribed 15 g of 'maqianzi' to be taken in two doses at 7 hours apart, although the recommended dose was 0.3-0.6 g. She was apparently well after drinking the first of two bowls of 'maqianzi' decoction. One hour after she drank the second bowl of herbal decoction, she suddenly developed tonic contractions of all her limb muscles and carpopedal spasm lasting 5 min, difficulty in breathing, chest discomfort and perioral numbness. The second bowl of decoction probably became more concentrated because of evaporation of water during continued boiling and contained a larger amount of 'maqianzi'. On arrival in the hospital 1 hour later, she complained of muscle pain and tiredness. She was found to have hyperventilation and weakness of four limbs, with muscle power of grade 5(-)/5. All her symptoms gradually subsided over the next few hours. This case illustrated that 'maqianzi' can cause strychnine poisoning even after processing, especially when the recommended dose is greatly exceeded. In any patient with 'unexplained' muscle spasms or convulsions, strychnine poisoning should be included in the differential diagnosis and they should be asked about the use of herbal medicines.

Ingestion of medicated oils by adults: the risk of severe salicylate poisoning is related to the packaging of these products.

Ingestion of medicated oils containing methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning. In this retrospective study of 24 adults who had ingested 'White Flower Oil' (n=18) or 'Red Flower Oil' (n=6), the main objective was to determine if the risk of severe salicylate poisoning was related to the product packaging. 'Red Flower Oil' had a large bottle opening so that its content could be emptied much more easily. It also had a larger bottle size and usually had a higher methyl salicylate concentration than 'White Flower Oil'. Patients tended to ingest a greater amount of 'Red Flower Oil' than 'White Flower Oil'. Five per cent of subjects who had taken 'White Flower Oil', but 67% of subjects who had taken 'Red Flower Oil', had admission plasma salicylate level >2.2 mmol/L (P=0.006). None of the subjects who had ingested 'White Flower Oil', but 50% of subjects who had taken 'Red Flower Oil', had moderate to severe symptoms (P=0.010). As a result, none of the subjects who had ingested 'White Flower Oil', but 33% of subjects who had taken 'Red Flower Oil', required urine alkalinization (P=0.054). One patient who had taken 'Red Flower Oil' died because of hospital-acquired pneumonia. All other patients made a complete recovery. To reduce the amount of methyl salicylate that can be readily swallowed during accidental or deliberate ingestion of medicated oils, improvements are needed in the existing packaging of these products.