strychnine poisoning
Patients poisoned with strychnine will have a rapid onset of symptoms, typically within an hour of exposure. Diffuse, involuntary muscle contractions are the hallmark of toxicity. Episodes of muscle contractions are classically caused by innocuous stimuli, such as turning on a light or loud sounds. Because of the arrangement and relative strength of the various muscle groups within the body, a patient will demonstrate flexion of the upper extremities and extension of the lower extremities. Characteristic facial muscle spasms also occur, where the eyebrows elevate, and an open, sustained grin appears (Sardonic grin). A phenomenon, called opisthotonus may also occur, in which severe contraction of the paraspinal muscles causes a characteristic arching posture of the neck and back. Typically the patient remains fully alert during these episodes, which may last up to two minutes, and recur for up to 24 hours. Other clinical effects include hyperthermia resulting from sustained muscle activity, as well as hemodynamic instability.
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