Editing Strychnine (section)

== Treatment ==
There is no [[antidote]] for strychnine poisoning.<ref>{{Cite web |date=2023-05-26 |title=Strychnine: Biotoxin {{!}} NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750018.html |access-date=2024-08-12 |website=www.cdc.gov |language=en-us}}</ref> Strychnine poisoning demands aggressive management with early control of muscle spasms, intubation for loss of airway control, toxin removal ([[decontamination]]), intravenous hydration and potentially active cooling efforts in the context of hyperthermia as well as [[hemodialysis]] in kidney failure (strychnine has not been shown to be removed by hemodialysis).<ref name="CDC_card2">{{cite web |title=CDC – The Emergency Response Safety and Health Database: Biotoxin: Strychnine – NIOSH |url=https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750018.html |url-status=live |archive-url=https://web.archive.org/web/20151221180423/http://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750018.html |archive-date=2015-12-21 |access-date=2016-01-02 |website=www.cdc.gov}}</ref> Treatment involves oral administration of [[activated charcoal]], which [[Adsorption|adsorbs]] strychnine within the digestive tract; unabsorbed strychnine is removed from the stomach by [[gastric lavage]], along with [[tannic acid]] or [[potassium permanganate]] solutions to oxidize strychnine.<ref>{{Cite journal |last=Patocka |first=Jiri |date=December 2015 |editor-last=Gupta |editor-first=Ramesh C. |title=Strychnine |url=https://www.researchgate.net/publication/282272675 |journal=Handbook of Toxicology of Chemical Warfare Agents |edition=2nd |publisher=Elsevier Inc. |pages=215–222 |doi=10.1016/B978-0-12-800159-2.00017-8 |isbn=978-0-12-800159-2 |via=ResearchGate}}</ref>

=== Activated charcoal ===
[[Activated carbon|Activated charcoal]] is a substance that can bind to certain toxins in the digestive tract and prevent their absorption into the bloodstream.<ref>{{cite web |title=Charcoal, Activated (Oral Route) Proper Use - Mayo Clinic |url=https://www.mayoclinic.org/drugs-supplements/charcoal-activated-oral-route/proper-use/drg-20070087 |url-status=live |archive-url=https://web.archive.org/web/20240206023304/https://www.mayoclinic.org/drugs-supplements/charcoal-activated-oral-route/proper-use/drg-20070087 |archive-date=2024-02-06 |access-date=2024-02-06 |website=[[Mayo Clinic]]}}</ref> The effectiveness of this treatment, as well as how long it is effective after ingestion, are subject to debate.<ref name="pmid150802072">{{cite journal |vauthors=Shadnia S, Moiensadat M, Abdollahi M |date=April 2004 |title=A case of acute strychnine poisoning |journal=Veterinary and Human Toxicology |volume=46 |issue=2 |pages=76–9 |pmid=15080207 |s2cid=23272093}}</ref><ref name="pmid290837952">{{cite book |title=Strychnine Toxicity |vauthors=Otter J, D'Orazio JL |date=August 7, 2023 |publisher=StatPearls |pmid=29083795 |id={{NCBIBook|NBK459306}}}}</ref><ref name="pmid85402352">{{cite journal |vauthors=Cooney DO |date=August 1995 |title=Evaluation of the US pharmacopeia adsorption tests for activated charcoals and proposals for changes |journal=Veterinary and Human Toxicology |volume=37 |issue=4 |pages=371–7 |pmid=8540235 |s2cid=67975596}}</ref> According to one source, activated charcoal is only effective within one hour of poison being ingested, although the source does not regard strychnine specifically.<ref>{{cite journal |last=Lapus |first=Robert Michael |date=April 2007 |title=Activated charcoal for pediatric poisonings: the universal antidote? |url=https://emergency.med.ufl.edu/files/2013/02/Activated-charcoal.pdf |url-status=live |journal=Current Opinion in Pediatrics |volume=19 |issue=2 |pages=216–222 |doi=10.1097/MOP.0b013e32801da2a9 |pmid=17496769 |s2cid=6728477 |archive-url=https://web.archive.org/web/20240206022505/https://emergency.med.ufl.edu/files/2013/02/Activated-charcoal.pdf |archive-date=2024-02-06 |access-date=2024-02-06}}</ref> Other sources specific to strychnine state that activated charcoal may be used after one hour of ingestion, depending on dose and type of strychnine-containing product.<ref>{{cite journal |vauthors=Hayden JW, Comstock EG |date=1975 |title=Use of Activated Charcoal in Acute Poisoning |url=https://www.tandfonline.com/doi/pdf/10.3109/15563657508988096 |url-status=live |journal=Clinical Toxicology |volume=8 |issue=5 |pages=515–533 |doi=10.3109/15563657508988096 |pmid=770060 |s2cid=42542989 |archive-url=https://web.archive.org/web/20240308030358/https://www.tandfonline.com/doi/pdf/10.3109/15563657508988096 |archive-date=2024-03-08 |access-date=2024-02-06}}</ref><ref name="pmid290837952" /> Therefore, other treatment options are generally favoured over activated charcoal.<ref name="pmid290837952" /><ref>{{cite web |date=16 January 2020 |title=CDC Strychnine &#124; Facts about Strychnine &#124; Public Health Emergency Preparedness& Response |url=https://emergency.cdc.gov/agent/strychnine/basics/facts.asp |url-status=live |archive-url=https://web.archive.org/web/20240206022505/https://emergency.cdc.gov/agent/strychnine/basics/facts.asp |archive-date=6 February 2024 |access-date=6 February 2024}}</ref> 

The use of activated charcoal is considered dangerous in patients with tenuous airways or altered mental states.<ref>{{cite journal |vauthors=Smith BA |year=1990 |title=Strychnine poisoning |journal=The Journal of Emergency Medicine |volume=8 |issue=3 |pages=321–325 |doi=10.1016/0736-4679(90)90013-L |pmid=2197324}}</ref> 

=== Other treatments ===
Most other treatment options focus on controlling the convulsions that arise from strychnine poisoning. These treatments involve keeping the patient in a quiet and darkened room,<ref>{{Cite web |title=Drugs and Poisons Fact Sheet: Strychnine Permits - What you need to know |url=https://www.bulloo.qld.gov.au/downloads/file/978/9-strychnine-guide |access-date=12 August 2024 |publisher=Queensland Health}}</ref> [[anticonvulsants]] such as [[phenobarbital]] or [[diazepam]],<ref name="CDC_card2" /> muscle relaxants such as [[dantrolene]],<ref>{{Cite web |title=Final Diagnosis -- Case 550 |url=https://path.upmc.edu/cases/case550/dx.html |access-date=2024-08-12 |website=path.upmc.edu}}</ref> barbiturates and [[propofol]],<ref>{{cite journal |vauthors=Lages A, Pinho J, Alves R, Capela C, Lourenço E, Lencastre L |date=16 May 2013 |title=Strychnine Intoxication: A Case Report |journal=Journal of Medical Cases |volume=4 |issue=6 |pages=385–388 |doi=10.4021/jmc1189w |s2cid=54707248 |doi-access=free}}</ref> and [[chloroform]] or heavy doses of [[chloral]], [[bromide]], [[Ethyl carbamate|urethane]] or [[amyl nitrite]].<ref>{{cite book |title=Pharmacology and Therapeutics |vauthors=Cushny AR |date=January 1, 1940 |publisher=Lea & Febiger |edition=12 |asin=B000SNDA1U}}</ref><ref name="pmid296408802">{{cite journal |vauthors=Buckley S |date=September 1873 |title=Case of Strychnine Poisoning Successfully Treated by Atropine |journal=Edinburgh Medical Journal |volume=19 |issue=3 |pages=211–213 |pmc=5315983 |pmid=29640880 |s2cid=4760315}}</ref><ref>{{cite journal |date=1932 |title=The Treatment of Strychnine Poisoning |url=https://jamanetwork.com/journals/jama/article-abstract/280615 |url-status=live |journal=Journal of the American Medical Association |volume=98 |issue=23 |page=1992 |doi=10.1001/jama.1932.02730490038013 |archive-url=https://web.archive.org/web/20240206023304/https://jamanetwork.com/journals/jama/article-abstract/280615 |archive-date=2024-02-06 |access-date=2024-02-06}}</ref><ref>{{cite web |date=8 September 2021 |title=Strychnine and Vomit: The Untold Story of Past US Addiction Treatments |url=https://filtermag.org/strychnine-addiction-treatments/ |url-status=live |archive-url=https://web.archive.org/web/20240206023305/https://filtermag.org/strychnine-addiction-treatments/ |archive-date=6 February 2024 |access-date=6 February 2024}}</ref> If a poisoned person is able to survive for 6 to 12 hours subsequent to initial dose, they have a good prognosis.<ref name="CDC_card2" />

The [[Sine qua non#Usage in medicine|sine qua non]] of strychnine toxicity is the "awake" seizure, in which tonic-clonic activity occurs but the patient is alert and oriented throughout and afterwards.<ref>{{cite journal |vauthors=Boyd RE, Brennan PT, Deng JF, Rochester DF, Spyker DA |date=March 1983 |title=Strychnine poisoning. Recovery from profound lactic acidosis, hyperthermia, and rhabdomyolysis |journal=The American Journal of Medicine |volume=74 |issue=3 |pages=507–512 |doi=10.1016/0002-9343(83)90999-3 |pmid=6829597 |s2cid=3222667}}</ref> Accordingly, [[George Harley (physician)|George Harley]] (1829–1896) showed in 1850 that [[curare]] (wourali) was [[Curare#History|effective]] for the treatment of tetanus and strychnine poisoning.