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4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katiha...

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Drug

Treatment Details

Strychnos nux vomica (kuchila)

Route : Ingestion of 1-2 crushed seeds. Intact seeds are not poisonous.

Fatal Period : 1-2 hours

Mechanism of action : Strychnine stimulates all the parts of central nervous system especially anterior horn cells of spinal cord causing greatly increased reflex excitability so that even slight stimulus like noise, light or air etc. causes generalized contractions of the muscles

Clinical picture : •Bitter taste
• Twitching and stiffness of face and neck muscles
• Strychnine convulsions: initially they are intermittent but then become sustained. any small stimulus like movements of patient, noise touch, light or water produces convulsions. Muscles become stiff and rigid so that body is thrown into an arch form.
1. Only head and heel touching ground{ convexity upwards} – opisthotonus posture
2. only back touching {convexity downwards} – emprosthotonus posture
3. Arching sideways – pleurosthotonus posture
• Fixed chest, difficulty in breathing and cyanosis
• Blood stained froth at nose and mouth
• Rhisus sardonicus {fixed monkey like grin}
• Eyes prominent and starring , with dilated pupils
• Mind remains clear till end
• Death occurs due to :
1. Medullary paralysis,
2. Asphyxia, due to spasm of respiratory muscles
3. Exhaustion

Treatment : • Shift patient to dark quiet room.
• Anaesthetise the patient
• Antidote: Barbiturates as phenobarbitone sodium{i.v.}
• Other drugs like muscle relaxants like succinylcholine, curare can be given
• Artificial respiration
• Gastric lavage with tannic acid, strong tea or KMnO4

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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

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