Strychnine poisoning From air medical transport to pediatric management

Main Article Content

Juliana Sartorelo Carneiro Bittencourt Almeida
Lara Miranda Rodrigues da Cunha
Renato Cançado Lasmar
Larissa de Paiva Oliveira
Adebal De Andrade Filho
Caio Gonçalves Nogueira

Abstract

Abstract: Vibration, light and noise are important flight stressors generated by aerospace physiology that directly impact the medical transport of a patient with a Strychnine intoxication, a toxic alkaloid extracted from the seed of Strychnos nux vomica, formerly used as a rodenticide, that was banned in the 90s due to its high lethality. Poisoning by the substance is rare and serious, and its management is complex. Case description: Patient, 2 years and 11 months old, male, admitted to the pediatric emergency department, via air transport, after suspected exogenous strychnine poisoning. The child received supportive treatment, with good response, and was discharged without sequelae. Discussion: This case report a very rare intoxication and correlate it with the need for protective measures for these flight changes, not only to improve teamwork, but primarily to prevent the poor clinical evolution of the victim. In addition, the specifics of the pediatric management of the victim are detailed. Such precautions can be extended to other pathologies that require restriction of noise, stimuli and vibrations. Conclusion: A quick detection, assertive management and measures that reduce stressful situations are essential for a good prognosis in Strychnine intoxication.

Article Details

How to Cite
Sartorelo Carneiro Bittencourt Almeida, J., Miranda Rodrigues da Cunha, L., Cançado Lasmar, R., de Paiva Oliveira, L., De Andrade Filho, A., & Gonçalves Nogueira, C. (2023). Strychnine poisoning: From air medical transport to pediatric management. LAJEC - Latin American Journal of Emergency Care, 3(3), e23020. https://doi.org/10.54143/jbmede.v3i3.137
Section
Case Reports
Author Biographies

Juliana Sartorelo Carneiro Bittencourt Almeida, Hospital João XXIII

Doctor graduated in 2006 from UFMG, residency in Internal Medicine at Hospital João XXIII, Titled in Medical Toxicology from AMB, Master in Infectious Diseases and Tropical Medicine from UFMG. She is currently preceptor and on duty at the Center for Information and Toxicological Assistance of Minas Gerais (CIAToxMG), Member of the board of the Brazilian Association of Emergency Medicine (ABRAMEDE) Regional MG and of the Toxicology Committee of ABRAMEDE Nacional. Founding partner of the company Logos for continuing education in Toxicology.

Lara Miranda Rodrigues da Cunha, Hospital João XXIII

Médica Emergencista com Residência no Hospital das Clínicas da Universidade Federal de Minas Gerais

Renato Cançado Lasmar, Hospital João XXIII

Residência em Pediatria, Especialização em Emergência Pediátrica, pediatra no Hospital João XXIII, 

Larissa de Paiva Oliveira, Hospital João XXIII

Residência em Pediatria, Pediatra no Hospital João XXIII

Adebal De Andrade Filho, Hospital João XXIII

Médico Clínico, Titulado em Toxicologia Médica, Coordenador do CIATOXMG

Caio Gonçalves Nogueira, Hospital João XXIII

Médico Emergencista, residência no Hospital das Clínicas da UFMG, plantonista do Transporte aeromédico do SAMU de Belo Horizonte

References

Referências Bibliográficas

Basualdo W. Intoxicación por estricnina [Strychnine poisoning]. Rev Med Chil. 1980 Feb;108(2):181-2. Spanish. PMID: 7244457.

Prat S, Hoizey G, Lefrancq T, Saint-Martin P. An unusual case of strychnine poisoning. J Forensic Sci. 2015 May;60(3):816-7. doi: 10.1111/1556-4029.12706. Epub 2015 Feb 20. PMID: 25702781.

Smith BA. Strychnine poisoning. J Emerg Med. 1990 May-Jun;8(3):321-5. doi: 10.1016/0736-4679(90)90013-l. Erratum in: J Emerg Med 1991 Nov-Dec;9(6):555. PMID: 2197324.

Yamarick W, Walson P, DiTraglia J. Strychnine poisoning in an adolescent. J Toxicol Clin Toxicol. 1992;30(1):141-8. doi: 10.3109/15563659208994455. PMID: 1542144.

Robert E. Gosselin, Harold Carpenter Hodge. Clinical Toxicology of Commercial Products: Acute Poisoning. Baltimore, Md.: Williams & Wilkins, 4ª edition, 1976.

Santhosh GJ, Joseph W, Thomas M. Strychnine poisoning. J Assoc Physicians India. 2003 Jul;51:739-40. PMID: 14621058.

Perper JA. Fatal strychnine poisoning--a case report and review of the literature. J Forensic Sci. 1985 Oct;30(4):1248-55. PMID: 4067548.

Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. PORTARIA Nº 344, DE 12 DE MAIO DE 1998(*) - Aprova o Regulamento Técnico sobre substâncias e medicamentos sujeitos a controle especial. Disponível em : https://bvsms.saude.gov.br/bvs/saudelegis/svs/1998/prt0344_12_05_1998_rep.html.

Wood D, Webster E, Martinez D, Dargan P, Jones A. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Crit Care. 2002 Oct;6(5):456-9. doi: 10.1186/cc1549. Epub 2002 Jul 10. PMID: 12398788; PMCID: PMC130147.

Hur MH, Havalad V, Clardy C. Strychnine: Old Remedy, Silent Killer. Pediatr Ann. 2019 May 1;48(5):e205-e207. doi: 10.3928/19382359-20190422-04. PMID: 31067337.

Brunton, L.L. Goodman & Gilman: As Bases Farmacológicas da Terapêutica. 12ª ed. Rio de Janeiro: McGraw-Hill, 2012.

Starretz-Hacham O, Sofer S, Lifshitz M. Strychnine intoxication in a child. Isr Med Assoc J. 2003 Jul;5(7):531-2. PMID: 12901256.

Lambert JR, Byrick RJ, Hammeke MD. Management of acute strychnine poisoning. Can Med Assoc J. 1981 May 15;124(10):1268-70. PMID: 7237316; PMCID: PMC1705440.

Fábio A, Antoniuk SA, Bruck I, Santos LC dos. Tratamento do estado de mal epiléptico em pediatria: revisão e proposta de protocolo. J epilepsy clin neurophysiol [Internet]. 2005 Dec;11(4):183–8. Available from: https://doi.org/10.1590/S1676-26492005000400006

Mb I, Tonk RS, Sahu SK. A Case of Strychnine Poisoning. J Assoc Physicians India. 2020 Jan;68(1):105. PMID: 31979967.

Hur MH, Havalad V, Clardy C. Strychnine: Old Remedy, Silent Killer. Pediatr Ann. 2019 May 1;48(5):e205-e207. doi: 10.3928/19382359-20190422-04. PMID: 31067337.

Makarovsky I, Markel G, Hoffman A, Schein O, Brosh-Nissimov T, Tashma Z, Dushnitsky T, Eisenkraft A. Strychnine--a killer from the past. Isr Med Assoc J. 2008 Feb;10(2):142-5. PMID: 18432030.

GAMA, Ana Paula et al. Avaliação do impacto sonoro no tráfego de helicópteros em áreas urbanas. 2012. Tese de Doutorado.

Insoft, R. M. Schwartz, H. P., Romito, J., Alexander, S. N., & American Academy of Pediatrics. (2016). Guidelines for air and ground transport of neonatal and pediatric patients (No. Electronic Books155356).

SANTOS, Juliano da Silva. Causas e consequências de vibrações em aeronaves. AS350. 2018.

Fouts, Brittany, and Darcy Mortimer. "Stresses of Flight during Aeromedical Transport: An Integrated Review." (2018).

Hathaway, Karyn and Rodgers, Sarah. “An Introduction to Aeromedical Transport: Course Manual.” (2017).

CAMARGOS, Nelson Santana. As vibrações de corpo inteiro no transporte aeromédico de pacientes neonatos pelo corpo de bombeiros militar de Minas Gerais. 2022. Trabalho de Conclusão de Curso de Especialização em Gestão de Políticas Públicas.

Similar Articles

You may also start an advanced similarity search for this article.