ABSTRACT
Strychnine was used as a pesticide until 1968 and a rodenticide until 2006 when its sale was banned throughout the EU and all supplies recalled. A case of strychnine poisoning seen in a UK emergency department in 2009 is reported to remind clinicians of the features and management of this increasingly rare presentation. Prompt recognition and early intensive supportive therapy can result in a favourable outcome.
Subject(s)
Methocarbamol/poisoning , Pesticides/poisoning , Strychnine/poisoning , Suicide, Attempted , Critical Care/methods , Critical Illness/therapy , Drug Therapy, Combination , Emergency Service, Hospital , Female , Follow-Up Studies , Humans , Intubation, Intratracheal , Middle Aged , Risk Assessment , Treatment OutcomeABSTRACT
A case is presented of a fatal drug interaction caused by ingestion of methocarbamol (Robaxin) and ethanol. Methocarbamol is a carbamate derivative used as a muscle relaxant with sedative effects. Therapeutic concentrations of methocarbamol are reported to be 24 to 41 micrograms/mL. Biological fluids were screened for ethanol using the Abbott TDx system and quantitated by gas-liquid chromatography (GLC). Determination of methocarbamol concentrations in biological tissue homogenates and fluids were obtained by colorimetric analysis of diazotized methocarbamol. Blood ethanol concentration was 135 mg/dL (0.135% w/v) and urine ethanol was 249 mg/dL (0.249% w/v). Methocarbamol concentrations were: blood, 257 micrograms/mL; bile, 927 micrograms/L; urine, 255 micrograms/L; gastric, 3.7 g; liver, 459 micrograms/g; and kidney, 83 micrograms/g. The combination of ethanol and carbamates is contraindicated since acute alcohol intoxication combined with carbamate usage can lead to combined central nervous system depression as a result of the interactive sedative-hypnotic properties of the compounds.
Subject(s)
Alcoholic Intoxication , Methocarbamol/poisoning , Adult , Chromatography, Gas , Colorimetry , Drug Interactions , Ethanol/blood , Humans , Male , Methocarbamol/analysisABSTRACT
A fatal methocarbamol intoxication is presented. Significant toxicologic findings were blood concentrations of 525 mg/L methocarbamol and 140 mg/dL ethanol. Analysis was by thin-layer, gas-liquid, and high pressure liquid chromatography. Toxicology data relevant to the interpretation of case findings are discussed.
