Convulsions following bupivacaine infiltration for excision of carotid body tumour.

nificant proportion of the toxin may be excreted unchanged in urine. 5 The fatal dose of strychnine is variable and patients have survived ingestion of large doses (grams) of strychnine. 6 There is no specific treatment for strychnine poisoning. Management is supportive, along the lines of most poisonings. The stomach is lavaged and activated charcoal administered to prevent further absorption of the toxin. 3 Muscle spasms are controlled by nursing the patient in a quiet environment, with benzodiazepine or barbiturate sedation. Uncontrolled muscle spasms require the addition of muscle relaxants and mechanical ventilation. Complications of strychnine poisoning include ventilatory failure and hypoxaemia due to the muscle spasms. 4 The increased muscle activity may result in rhabdomyolysis,4 an effect seen to a minor degree in our patient. The intense muscle spasms and rhabdomyolysis may also result in lactic acidosis, hyperthermia 7 and renal failure. 4 Anoxic brain damage and renal failure are the usual causes of death in strychnine poisoning. 1.4 Strychnine poisoning does not commonly present to hospitals in Australia, but the classical clinical course must be recognised early and aggressive therapy instituted to minimise complications.