Figure 291

Patient in opisthotonos.

agents produce convulsions that can be followed by coma and death. Convulsions produced by this class of agents (with the exception of strychnine) are usually tonic-clonic and are uncoordinated. In some cases, the convulsions are preceded by marked stimulation of respiration, tachycardia, and excessive pressor effects.

The uncontrolled excitation that occurs after accidental or intentional strychnine ingestion (in the absence of normal inhibition) results in characteristic convulsions. In humans, in whom extensor muscles are normally dominant, tonic extension of the body and all limbs is observed. This hyperextension is known as opisthotonos; at its extreme, it consists of a characteristic posture in which the back is arched and only the back of the head and the heels are touching the surface on which the victim is lying. Figure 29.1 illustrates a patient in opisthotonos. Under the influence of strychnine, all sensory stimuli produce exaggerated responses. The primary therapeutic consideration after strychnine poisoning is to prevent convulsions, which may be fatal. Diazepam and clonazepam (see Chapter 33) appear to be moderately effective in preventing strychnine convulsions, and either of these is the agent of choice. Barbiturates are often used to treat overdoses of all of the analeptic stimulants. Generally, however, antidotal therapy is not required.

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