A Seizuring Child: Accidental Ingestion of an Ancient Remedy

Excerpt

To the Editor: A 3-y-old boy presented with accidental ingestion of a herbal medication, allegedly meant for his mother for her skin allergy. Post ingestion, child had a generalized tonic seizure lasting for 10 min. He was brought in cardiac arrest. Post revival, child was put on synchronised intermittent mandatory ventilation (SIMV), started on adrenaline and phenytoin infusion. At 2 h, he had a seizure recurrence aborted with lorazepam and phenytoin. On enquiry, mother showed the seed of the herbal remedy and labeled it as ‘kuchla’. Post stabilization, child underwent gastric lavage. Serum and gastric lavage samples and the herbal-remedy seed were sent for toxicological analysis. His laboratory investigations and electrocardiogram done post-resuscitation were normal. Adrenaline infusion was stopped and the child was extubated the same day at 6 h. Patient was discharged on day 3 with stable vitals till 6 mo followup. Electroencephalogram done after discharge was normal. Toxicological analysis performed by Shimadzu GC-MS-QP-2020 NX Gas Chromatography-Mass Spectrometry identified the seed ‘kuchla’ as seed of the plant Strychnos nuxvomica. Extraction of strychnine from gastric lavage showed strychnine levels of 12.9 mg/L. Strychnine was undetectable in initial blood sample. …