Case Definition: Strychnine

Clinical description

The major identifying clinical features of strychnine poisoning through ingestion are severe, painful spasms of the neck, back, and limbs and convulsions with an intact sensorium. Signs and symptoms might progress to coma. Tachycardia and hypertension are also common adverse health effects (1-4).

Laboratory criteria for diagnosis

• Biologic: A case in which strychnine in urine or serum is detected, as determined by a laboratory (5).

- OR-

• Environmental: Detection of strychnine in environmental samples (6-9).

Case classification

• Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
• Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for strychnine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
• Confirmed: A clinically compatible case in which laboratory tests of biologic and environmental samples have confirmed exposure.

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.

Additional resources

1. Chan Y. Chapter 112 - Strychnine. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE, eds. Goldfrank's Toxicologic Emergencies. 9th ed. New York, NY: McGraw-Hill; 2011:1445-9.
2. Edmunds M, Sheehan TM, Van't Hoff W. Strychnine poisoning: clinical and toxicological observations of a non-fatal case. J Toxicol Clin Toxicol 1986;24:245-55.
3. Smith BA. Strychnine poisoning [review]. J Emerg Med 1990;321-5.
4. Perper JA. Fatal strychnine poisoning---a case report and review of the literature. J Forensic Sci 1985;30:1248-55.
5. Heiser, JM; Daya, MR; et al. Massive Strychnine Intoxication: Serial Blood Levels in a Fatal Case, J Toxicol Clin Toxicol 30(2): 269-283, (1992).
6. NIOSH. NIOSH manual of analytical methods [online]. 2003. [cited 2013 Apr 5]. Available from URL: http://www.cdc.gov/niosh/docs/2003-154/.
7. OSHA. Sampling and analytical methods [online]. 2010. [cited 2013 Apr 5]. Available from URL: http://www.osha.gov/dts/sltc/methods/index.html.
8. FDA. Food: Laboratory methods [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.fda.gov/Food/FoodScienceResearch/LaboratoryMethods/default.htm.
9. EPA. Selected analytical methods: chemical methods query [online]. 2013. [cited 2013 Apr 5]. Available from URL: http://www.epa.gov/sam/searchchem.htm.