Editing Strychnine (section)

=== Human toxicity ===
[[File:Opisthotonus in a patient suffering from tetanus - Painting by Sir Charles Bell - 1809.jpg|thumb|An 1809 painting by [[Charles Bell]] depicting opisthotonus caused by tetanus]]

After injection, inhalation, or ingestion, the first symptoms to appear are generalized [[Spasm|muscle spasms]]. They appear very quickly after inhalation or injection – within as few as five minutes – and take somewhat longer to manifest after ingestion, typically approximately 15 minutes. With a very high dose, the onset of [[respiratory failure]] and [[brain death]] can occur in 15 to 30 minutes. If a lower dose is ingested, other symptoms begin to develop, including [[Epileptic seizure|seizures]], cramping, [[Muscle stiffness|stiffness]],<ref>{{cite journal | vauthors = Duverneuil C, de la Grandmaison GL, de Mazancourt P, Alvarez JC | title = Liquid chromatography/photodiode array detection for determination of strychnine in blood: a fatal case report | journal = Forensic Science International | volume = 141 | issue = 1 | pages = 17–21 | date = April 2004 | pmid = 15066709 | doi = 10.1016/j.forsciint.2003.12.010 | s2cid = 42860729}}</ref> [[hypervigilance]], and [[Agitation (dementia)|agitation]].<ref>{{cite journal | vauthors = Santhosh GJ, Joseph W, Thomas M | title = Strychnine poisoning | journal = The Journal of the Association of Physicians of India | volume = 51 | pages = 739–740 | date = July 2003 | pmid = 14621058}}</ref> Seizures caused by strychnine poisoning can start as early as 15 minutes after exposure and last 12–24 hours. They are often triggered by sights, sounds, or touch and can cause other adverse symptoms, including [[hyperthermia]], [[rhabdomyolysis]], myoglobinuric [[kidney failure]], [[metabolic acidosis]], and [[respiratory acidosis]]. During seizures, [[mydriasis]] (abnormal dilation), [[exophthalmos]] (protrusion of the eyes), and [[nystagmus]] (involuntary eye movements) may occur.<ref name="CDC_card" />

As strychnine poisoning progresses, [[tachycardia]] (rapid heart beat), [[hypertension]] (high blood pressure), [[tachypnea]] (rapid breathing), [[cyanosis]] (blue discoloration), [[diaphoresis]] (sweating), [[water-electrolyte imbalance]], [[leukocytosis]] (high number of [[white blood cell]]s), [[trismus]] (lockjaw), [[risus sardonicus]] (spasm of the facial muscles), and [[opisthotonus]] (dramatic spasm of the back muscles, causing arching of the back and neck) can occur. In rare cases, the affected person may experience [[nausea]] or [[vomiting]].<ref name="CDC_card" />

The proximate cause of death in strychnine poisoning can be [[cardiac arrest]], [[respiratory failure]], [[multiple organ failure]], or [[brain damage]].<ref name="CDC_card" />

{| class="wikitable sortable" style="margin-left:auto; margin-right:auto;"
|+ Minimum lethal dose estimates for strychnine in humans
|-
! scope="col" | Type
! scope="col" | Route
! scope="col" | Dose (mg)
! scope="col" class="unsortable" | Ref.
|-
| Human
| Oral
| 100–120
| <ref>{{cite book | date = January 15, 1994 | isbn = 978-0-8016-6676-6 | vauthors = Zenz C, Dickerson OB, Horvath EP | title = Occupational Medicine | edition = 3rd | pages = 640 | location = St Louis | publisher = Mosby}}</ref><ref>{{cite journal | vauthors = Palatnick W, Meatherall R, Sitar D, Tenenbein M | title = Toxicokinetics of acute strychnine poisoning | journal = Journal of Toxicology. Clinical Toxicology | volume = 35 | issue = 6 | pages = 617–620 | pmid = 9365429 | doi = 10.3109/15563659709001242 | year = 1997 | s2cid = 26117078}}</ref>
|-
| Human
| Oral
| 30–60
| <ref>{{cite book | vauthors = Lewis RG | date = 1996 | title = Sax's Dangerous Properties of Industrial Materials | edition = 9th | volume = 1–3 | page = 3025 | publisher = Van Nostrand Reinhold | location = New York}}</ref>
|-
| Human (child)
| Oral
| 15
| <ref>{{cite book | vauthors = Goodman LS, Gilman AG, Gilman AM | title = The pharmalogical basis of therapeutics | date = 1985 | location = New York | publisher = Macmillan Publishing & Co., Inc}}</ref><ref name="gossel">{{cite book | vauthors = Gossel TA, Bricker JD | date = 1994 | title = Principles of Clinical Toxicology | edition = 3rd | page = [https://books.google.com/books?id=dAoFh3vGsFQC&pg=PA351 351] | publisher = Raven Press | location = New York}}</ref>
|-
| Human (adult)
| Oral
| 50–100
| <ref>{{cite journal | vauthors = Migliaccio E, Celentano R, Viglietti A, Viglietti G | title = Avvelenamento da stricnina. Un caso clinico | trans-title = Strychnine poisoning. A clinical case | journal = Minerva Anestesiologica | language = it | volume = 56 | issue = 1–2 | pages = 41–42 | year = 1990 | pmid = 2215981 | s2cid = 30164858}}</ref>
|-
| Human (adult)
| Oral
| 30–100
| <ref name="gossel" />
|-
| Human
| Intravenous
| 5–10 (approximate)
| <ref>{{cite book | veditors = Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J | chapter = Strychnine | title = Medical Toxicology: Diagnosis and Treatment of Human Poisoning. | location = Baltimore | publisher = Williams & Wilkins | date = 1997 | pages = 1660–1662}}</ref>
|}

For occupational exposures to strychnine, the [[Occupational Safety and Health Administration]] and the [[National Institute for Occupational Safety and Health]] have set exposure limits at 0.15&nbsp;mg/m<sup>3</sup> over an 8-hour work day.<ref name="PGCH">{{cite web | title = Strychnine | url = https://www.cdc.gov/niosh/npg/npgd0570.html | work = CDC – NIOSH Pocket Guide to Chemical Hazards | access-date = 2017-09-15 | archive-date = 2017-05-11 | archive-url = https://web.archive.org/web/20170511071949/https://www.cdc.gov/niosh/npg/npgd0570.html | url-status = live}}</ref>

Because strychnine produces some of the most dramatic and painful symptoms of any known toxic reaction, strychnine poisoning is often portrayed in literature and film including authors [[Agatha Christie]] and [[Arthur Conan Doyle]].<ref>{{cite web | title = Chemistry in its element – strychnine | url = http://www.rsc.org/chemistryworld/podcast/CIIEcompounds/transcripts/strychnine.asp | publisher = Royal Society of Chemistry | access-date = 18 May 2016 | archive-date = 23 June 2016 | archive-url = https://web.archive.org/web/20160623221712/http://www.rsc.org/chemistryworld/podcast/CIIEcompounds/transcripts/strychnine.asp | url-status = live}}</ref>