The Usefulness of MS3 to Confirm Poisoning on the Example of Dog Poisoning with Strychnine.

Strychnine is an alkaloid with strong toxic properties. Poisoning results in muscular contractions and death through asphyxiation. Intentional or accidental poisonings with strychnine occur mainly in small animals, especially dogs and occasionally cats. Strychnine can be detected in the liver or stomach contents. Unfortunately, the determination of strychnine in these matrices, especially in postmortem examination, is subject to a significant matrix effect that makes it difficult to confirm the presence of the substance being determined. Therefore, we developed a new liquid chromatography method combined with mass spectrometry. One-gram homogenized samples were extracted and partitioned after adding acetonitrile and 5-mol solution of ammonium acetate. After extraction, the samples were analyzed using high-pressure liquid chromatography-MS/MS/MS. The results of validation fulfil the requirement of the confirmatory criteria according to SANTE/11945/2015 regarding apparent recoveries (98.97% to 104.0%), repeatability (2.9%-4.1%), and within-laboratory reproducibility (3.3%-4.6%). The method can be successfully applied to confirm strychnine poisoning cases.

Strychnine: Old Remedy, Silent Killer.

Toxin ingestion is a significant public health issue for children, accounting for hundreds of visits per day to emergency departments. The most common substances are household cleaning products, personal care products, and medications. This article describes an ingestion of a rare substance called strychnine, which is a plant-based odorless powder that was previously used as a nonspecific stimulant. This toxicity can mimic other ingestions, thus delaying diagnosis, so an increased awareness of the common symptoms and laboratory findings may lead to a more targeted management of strychnine poisoning. [Pediatr Ann. 2019;48(5):e205-e207.].

Geographical characteristics influencing the risk of poisoning in pet dogs: Results of a large population-based epidemiological study in Italy.

Pets can act as sentinels for human health and thus surveillance of pet dogs has the potential to improve awareness of emerging risks for animal and public health. The aim of this study was to investigate factors associated with the risk of canine poisoning. In a large population-based epidemiological investigation in Italy performed from January 2015 to January 2016 and April 2016 to April 2017, descriptive statistics were acquired and analysed to determine variables associated with poisoning events in pet dogs. Results were validated in a test population and forecast analysis of risk was performed. The cumulative incidence of poisoning events was low (10.2/1000 dogs/year). Anticoagulant rodenticides, organophosphate pesticides, metaldehyde and strychnine were the most frequent causes of intoxications. Territory characteristics significantly modulated both the frequency and the nature of the involved substances. The seashore area was associated with poisoning by rodenticides (odds ratio, OR, 1.81, 95% confidence interval, CI, 1.54-2.13) and metaldehyde (OR 1.61, 95% CI 1.16-2.28). The hill country area was associated with poisoning by organophosphate pesticides (OR 1.73, 95% CI 1.38-2.15), metaldehyde (OR 2.26, 95% CI 1.53-3.25) and strychnine (OR 1.86, 95% CI, 1.34-2.57). The mountain area was associated with strychnine poisoning (OR 3.79, 95% CI 2.84-5.06). The prospective cumulative incidence of poisoning over 10 years was 9.74% (95% CI 9.57-9.91). These results may be useful for predicting the risk of poisoning and for estimating the risk index related to specific toxic compounds in specific territories. This study suggests that poisoning events in dogs may represent a problem of public health with the potential to affect wildlife and human beings.

A Case of Strychnine Poisoning from a Southeast Asian Herbal Remedy.

BACKGROUND: Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe strychnine poisoning from ingestion of a Southeast Asian herbal supplement quantitatively confirmed by serum and urine analysis. CASE REPORT: A 40-year-old Cambodian woman presented to the emergency department with a complaint of jaw pain and spasms. The patient was staying with a relative and drank 2 oz from an unmarked bottle that she thought contained vodka. She then developed trismus and abdominal cramping, after which a family member said the bottle contained a compound called "slang nut." Her vital signs were as follows: heart rate 102 beats/min, blood pressure 142/72 mm Hg, respiratory rate 20 breaths/min, and oxygen level 100%. The physical examination revealed no significant abnormalities. Serum toxicologic screens were negative except for strychnine levels that revealed a serum concentration of 350 ng/mL and a urine concentration >200 ng/mL. The patient was observed for 2.5 h and discharged with no long-term complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Strychnine is a well-known compound that has been used in poisons, rodenticides, and performance enhancing drugs for years. In the Western world, strychnine is a much less common poisoning given that its use has been restricted because of the potential for severe toxicity; however, given its potentially high mortality, it is important to be aware of other sources of exposure, including those from herbal and homeopathic remedies.

[Strychnine poisoning: uncommon, but does still happen]. / Strychnine-intoxicatie: zeldzaam maar niet verdwenen.

BACKGROUND: Acute strychnine poisoning is an uncommon form of intoxication, characterized by severe tonic clonic seizures and tetanus-like contractions while the patient is fully conscious. It can result in respiratory failure, leading to death. CASE DESCRIPTION: A 47-year-old man was admitted to the casualty department 2 hours after self-poisoning with strychnine. The clinical picture consisted of persistent seizures, which were treated with midazolam and propofol. The patient went into respiratory failure and asystole, so intubation and cardiac massage were initiated. Other complications were severe metabolic acidosis, hyperthermia and rhabdomyolysis with renal failure. The treatment consisted of cooling, hyperhydration and intravenous administration of sodium bicarbonate. He was discharged to a mental care institution with no persistent symptoms 11 days later. CONCLUSION: Early aggressive treatment of a strychnine intoxication can be life-saving. Knowledge of the clinical picture and the right treatment is important. Treatment is primarily focussed on stopping the convulsions and securing the airway.

A retrospective study of canine strychnine poisonings from 1998 to 2013 in Western Canada.

This study describes observations related to 93 cases of strychnine poisoning in dogs over a 16-year period in Saskatchewan, Alberta, and Manitoba. Epidemiological information describing age, gender, breed, and size of the dogs, geographical distribution of poisonings, and strychnine concentrations in tissue matrices were tabulated. The mortality in dogs poisoned with strychnine was 60.2%. Strychnine poisoning cases varied by year (P = 0.0012) and by season (P = 0.0005). The highest number of confirmed cases occurred in years 2000 and 2001. Poisonings occurred most frequently during the spring. There were no statistical differences related to age or gender, but older, male dogs appeared to be more commonly affected. Large dog breeds were most commonly affected. Strychnine was detected in multiple tissue matrices, including stomach contents, liver, urine, vomitus, and gastric washings. The study indicates that strychnine poisoning in the dog remains a common toxicosis in western Canada.

Étude rétrospective des empoisonnements canins à la strychnine de 1998 à 2013 dans l'Ouest canadien. Cette étude décrit les observations se rapportant à 93 cas d'empoisonnement à la strychnine chez des chiens pendant une période de 16 ans en Saskatchewan, en Alberta et au Manitoba. Des renseignements épidémiologiques décrivant l'âge, le sexe, la race et la taille des chiens, la répartition géographique des empoisonnements et les concentrations de strychnine dans les matrices des tissus ont été compilés. La mortalité des chiens empoisonnés à la strychnine était de 60,2 %. Les cas d'empoisonnement à la strychnine variaient selon l'année (P = 0,0012) et selon la saison (P = 0,0005). Le nombre le plus élevé de cas confirmés s'est produit en 2000 et en 2001. Les empoisonnements se produisaient le plus fréquemment au printemps. Il n'y avait pas de différences statistiques reliées à l'âge ou au sexe, mais les chiens mâles âgés semblaient être le plus fréquemment touchés. Les chiens de grande race étaient le plus souvent affectés. La strychnine a été détectée dans des plusieurs matrices de tissus, notamment le contenu de l'estomac, le foie, l'urine, les vomissures et les lavages gastriques. L'étude indique que l'empoisonnement à la strychnine chez le chien demeure une toxicose commune dans l'Ouest canadien.(Traduit par Isabelle Vallières).

An unusual case of strychnine poisoning.

Strychnine-related death has been described since the 19th century. This alkaloid was discovered in 1818. Historically, strychnine was used by the South-East Asian autochthones on their arrows. However, its production was modified by legislation, which was used to protect people against accidental intoxications. Here, we present the case of a 69-year-old man who was found dead at home. During the autopsy, we found a blue substance in the stomach. Toxicological analysis measured strychnine at 0.29 µg/mL in the blood sample, which is a relatively low level in comparison with the results given in the literature. However, histologic examination and toxicological findings permitted the conclusion of strychnine poisoning.

Strychnine in amoxicillin capsules: a means of homicide.

Fatal strychnine poisoning is uncommon. It is no longer used as a therapeutic drug and its availability to the public is controlled by legislations in various jurisdictions, but it is still in use as a rodenticide and an adulterant in street drugs. Homicide by strychnine is extremely rare. As the autopsy findings are subtle, strychnine poisoning could easily be overlooked and a homicide may go undetected. This communication highlights an unusual case of homicide by strychnine. It is important that in deaths where there are no gross autopsy findings, sudden death in particular, that routine toxicology be performed, in which strychnine is likely to be detected.

Strychnine poisoning: gone but not forgotten.

Strychnine was used as a pesticide until 1968 and a rodenticide until 2006 when its sale was banned throughout the EU and all supplies recalled. A case of strychnine poisoning seen in a UK emergency department in 2009 is reported to remind clinicians of the features and management of this increasingly rare presentation. Prompt recognition and early intensive supportive therapy can result in a favourable outcome.

A rare case of brucine poisoning complicated by rhabdomyolysis and acute renal failure.

Brucine is the predominant alkaloid present in the bark of the tree Strychnos nux vomica and is a weaker alkaloid when compared to strychnine. However, its toxicological property is akin to strychnine. We report a rare case of brucine poisoning complicated by acute renal failure and rhabdomyolysis. A 24-year-old male presented with a history of consumption of a decoction made from the bark of the Strychnos nux vomica tree. Soon after, he developed widespread muscle spasms and convulsions, which were promptly treated. On the fifth day of admission, he developed features of rhabdomyolysis and acute renal failure. Investigations revealed elevated creatine phosphokinase levels and elevated blood urea and serum creatinine. The patient was managed with hemodialysis and recovered gradually. There are many reports of strychnine poisoning producing rhabdomyolysis and renal failure. In this case report, attention is drawn to the fact that brucine, although a weaker alkaloid, can also produce life threatening complications like rhabdomyolysis and acute renal failure.

The association of bait formulation of strychnine with poisonings in nontarget species in Saskatchewan from 1975 to 2007.

This study investigated the association of pre-mixed and freshly mixed strychnine baits with poisoning of nontarget animals in Saskatchewan. During years where the formulations were derived from a 2% concentrate, there was a greater than 2-fold increase in case numbers. There were approximately 3-fold fewer cases when the baits were prepared by pest control officers rather than by producers.

Decline in pesticide poisonings in the United States from 1995 to 2004.

BACKGROUND: Trends in rates of unintentional pesticide illnesses and injuries by type were estimated for the United States from 1995 to 2004. METHODS: Poison Control Center data were examined for the years 1995 through 2004. Rates were calculated for pesticide type and selected pesticide classes based on estimated total United States population and proportion of population served. Pesticides as a proportion of poisonings to all substances over the years and vital statistics on deaths were examined to validate trends. RESULTS: Incidence rates of serious pesticide poisonings and injuries have declined 42% from 1995 to 2004 and death rates declined 62% over the same period. Selected, more toxic pesticides such as organophosphate and carbamate insecticides, strychnine rodenticides, and paraquat herbicides have shown greater declines, ranging 63% to 79%. CONCLUSIONS: Pesticide poisonings and injuries appear to have declined in the past decade.

Determination of strychnine in human blood using solid-phase extraction and GC-EI-MS.

A rapid, simple, and sensitive method has been developed for the identification and quantitation of strychnine in human blood. The sample cleanup procedure involved solid-phase extraction with Oasis(R) HLB cartridges. The extracts were analyzed by gas chromatography-electron impact ionization-mass spectrometry. Limits of detection (LOD) and quantitation (LOQ) were 0.03 and 0.10 microg/mL, respectively, and the method was found to be linear between the LOQ and 2.5 microg/mL, with a correlation coefficient of 0.9994. Intra- and interday precision and accuracy were determined at both low and high concentrations (0.50 and 2.00 microg/mL). The CVs ranged from 5.63 to 8.50% and bias was within +/- 10% of the true value. Mean recovery of strychnine was 90.7%. Because of its simplicity and speed, the described method can be applied in forensic toxicology laboratories to determine this alkaloid in whole blood samples. Also, the fact that only 0.5 mL of blood is required to accomplish the analysis make this procedure useful in situations where several exams are needed and the sample volume is limited.

[Study of toxicology of strychnos].

Because of its officinal value, strychnos is widely used by clinic and individual. Since toxic dose and therapeutic dose are very close, strychnos poisoning cases are frequently reported. In this paper the chemical component, toxic dose, mechanisms of toxicity, poisoning symptom and pathological changes after strychnos poisoning are reviewed.

[Strychnine poisoning]. / Strychninvergiftung.

HISTORY AND ADMISSION FINDINGS: A 46-year-old man presented two hours after ingestion of about 250 mg strychnine with severe violent, generalized convulsions, triggered by external stimuli. During the convulsion-free periods there were no abnormal signs in the physical examination. INVESTIGATION: The presence of strychnine was confirmed by urine analysis with gas chromatography-mass spectrometry. TREATMENT AND COURSE: Because diazepam as anticonvulsant of choice was not effective in abating the convulsions the patient was intubated. A combination with midazolam, fentanyl and pancuronium was effective in controlling the convulsions. The patient was discharged from ICU on day three. CONCLUSION: Fatal outcome of strychnine poisoning demands an aggressive management with early intubation, control of muscle tremors and prevention of rhabdomyolisis and renal failure.

A case of acute strychnine poisoning.

In most severe cases of strychnine poisoning, the patient dies before reaching the hospital. This report describes the treatment and successful outcome of a patient who had taken a dose of strychnine that would normally be fatal. A 28-y-old man was admitted 2 h after ingestion of 1 to 1.5 g of strychnine. He had a Glasgow Coma Score of 14/15 and was severely agitated and in mild respiratory distress; blood pressure was 90/60 mmHg, pulse 110/min, and peripheral pulses weak. He had generalized hyperactive reflexes and had several generalized tonic-clonic convulsions in the emergency department. Treatment consisted of gastric lavage with water, oral administration of activated charcoal and sorbitol solution, continuous intravenous administration of midazolam and then sodium thiopental, furosemide, sodium bicarbonate and hemodialysis for acute renal failure. His clinical course included respiratory distress, agitation, generalized tonic-clonic convulsions, hyperactivity, oliguria and acute tubular necrosis prior to recovery in 23 days. This patient ingested what would normally be a fatal amount of strychnine, had signs and symptoms of severe toxicity and recovered, suggesting that with aggressive supportive care patients may have favorable outcomes.

Strychnine overdose following ingestion of gopher bait.

A 52-year-old male was discovered supine on his bed in a state of early decomposition. Commercial strychnine-treated gopher pellets were found in the home, and suicide notes were present at the scene. Biological fluids and tissues were tested for basic, acidic, and neutral drugs using gas chromatography-mass spectrometry. Concentrations of strychnine in heart and femoral blood were 0.96 and 0.31 mg/L, respectively. Vitreous fluid, bile, urine, liver, and brain specimens contained 0.36 mg/L, 1.17 mg/L, 2.92 mg/L, 4.59 mg/kg, and 0.86 mg/kg strychnine, respectively. No other drugs were detected in any of the samples. The cause of death was attributed to rodenticide poisoning, and the manner of death was suicide.