@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2019;25(4):189-192

Background
Strychnine is a natural alkaloid, which is used as pesticide for many years.
Previous Studies
Strychnine is a natural alkaloid discovered in 1818. It obtains from a variety of plants, among which Strychnos nux vomica is the most known ones. It can be found in southwest Asia, where indigenous people have used them for many years to poison their arrows. Strychnine was first synthesized in 1954 [2]. Since the 16th century, it has been used as a rodenticide. It has been used for many years as a disinfectant, a remedy for gastric, circulatory, and central nervous system disorders, and even as a performance-enhancing drug (doping). Its use as a poison for animal control has been widespread in recent years [3, 4], but due to the presence of more appropriate alternatives, using Strychnine was banned in the United States in 1972 [5] and throughout the European Union in 2006 [6]. Because of these prohibitions, poisoning with Strychnine is no longer common, but it is still important because in most cases, the patient dies before reaching the hospital [7].
Aim(s)
In this report, a case of suicide with Strychnine was presented.
Research type
This research was a case report.
Research society, place and time

Sampling method and number

Used devices&materials

Findings by Text
A social worker's death in a health center was reported to the forensic medicine in a village near Kermanshah. At the scene of the death, the 55-year-old man's body was found on a chair with legs straight, the spine spastic and backwards bent and head back. The hands were spastic and directly hanging on either side of the chair. The chair and desk status indicated the chair moving away from the desk. The corpse muscles were extremely hard and resembled premature rigor mortis, but it was relatively warm in touch. The corpse was autopsied and samples were taken from the stomach, gallbladder, blood, and right lobe of the liver to perform toxicological tests and were analyzed using thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). The autopsy examination, no petechial mucosa of the eyelids and eyes and no signs of suffocation in the neck were observed. The mucosa of the mouth was dry and highly pale. Symptoms similar to inflammation and superficial burns were seen in the mucosa of the mouth, lips, and pharynx. The discoloration of the gingiva was observed as red tooth margin. There was no lesion in the skull area. In the pharynx and larynx except for the inflammation of the upper respiratory tract mucosa, there was no remarkable sign. The lungs were anthracosis and had tissue edema and sporadic intracranial hemorrhage. The nail bed of both hands was cyanotic. There was a brief ischemia in the ventricular muscles. There were red suspended particles in the gastric and the gastric mucosa was full of blood. The liver and kidneys were brick red. The bladder lacked urine. The fact that the body was spastic and relatively warm, together with the condition of the chair and table indicated that there was a possibility of seizures, so a number of drugs and toxins should be considered. Therefore, medicines available at the health home were examined. Searching the place, a note was found about the suicide and its causes, as well as a glass containing almost a small amount of white solution on the floor. Given that strychnine had been used in rural health centers to kill stray dogs and rodents, on inquiries from the deceased's colleagues, it was found that, despite being banned and ordered to collect strychnine from health homes, it was still maintained in some of the centers, including this health home. In the laboratory results, using TLC, strychnine was found in the stomach contents and in viscera. The toxin found in the health home was used as a control in this experiment. Then, these samples were confirmed by HPLC using strychnine toxin. Also, histological specimens from lung, kidney, and heart were obtained, with no microscopic findings.
Main comparison to the similar studies
The mechanism of action of strychnine poisoning is well known. This toxin is a competitive antagonist for the inhibitory neurotransmitter glycine at its receptor site in the spinal cord, brainstem, and upper parts. It increases neuronal activity and excitability, which results in increased muscle activity [8]. The classic features of poisoning occur 15 to 30 min after ingestion, which include increased consciousness, spasm, and muscle tone and increased sensitivity to stimuli. In suicides, in which a large amount of poison is taken, these symptoms progress and become painful general seizures that during and after these seizures, the individual remains consciousness. The cause of death is usually secondary respiratory failure due to respiratory muscle spasm [9]. .. [11, 12]. After ingestion, strychnine is rapidly absorbed through the gastrointestinal tract. The toxin appears transiently in the blood, binds to its protein and is rapidly distributed to tissues [12]. In this case, the no toxin was found in the blood based on toxicology report, but it was detectable in viscera. Vomiting after eating strychnine is not common [9]. There was also no sign of vomiting in the death scene. Given the non-specific symptoms of acute poisoning with strychnine, definitive determination of the cause of death requires toxicological techniques. The most reliable methods include HPLC and gas chromatography-mass spectroscopy (GC-MS) [13]. ... [14, 15].
Suggestions

Limitations

Conclusions
Despite the ban on the use of strychnine, it seems that this poison is still used in some areas. By observing suicide cases, it seems that there is a need for more precise monitoring to prevent stereotypes.
Acknowledgments
We would like to thank the respected manager and staff of the Kermanshah Forensic Medicine Organization, and also the National Forensic Research Center.
Conflict of interest
None.
Ethical Permissions
There is no ethical consideration, since no names and information are used in this study.
Funding Sources
The study was funded by the Kermanshah Forensic Medicine Organization.