A 29-year-old male presented to the Emergency Department with convulsions after consumption of a decoction made from the bark of the Strychnos nux vomica tree confusing it for Alstonia scholaris. He drank the preparation along with four other members of the family as a part of a religious ritual. He had been following this religious ritual yearly (on the new moon day in the month of July) for the past 10 years. For the past 10 years his father used to get the bark of the tree from the forest before sunrise and prepare the decoction. As his father had passed away recently some other family member had prepared the decoction instead.
One hour after drinking the herbal preparation he vomited and subsequently developed an episode of generalised tonic clonic seizure. He also had a series of convulsions while being transported from his home to the hospital. The patient was alert between convulsions. The convulsions were precipitated by any form of physical contact. Other members of the family had mild muscular spasms and nausea.
On arrival at the Emergency Department the patient developed cardio-pulmonary arrest. Cardio-pulmonary resuscitation was initiated which was successful. A stomach washout was performed and the patient was intubated and ventilated. Anticonvulsant medications were initiated to prevent any further convulsions.
Initial investigations performed revealed renal failure (urea: 46mg/dl, creatinine: 1.8mg/dl) and an elevated creatine phosphokinase: 1005U/L. The arterial blood gas showed presence of metabolic acidosis.
Despite all efforts to stabilise the patient, he developed another episode of cardiac arrest shortly after admission, and died.
Subsequent to the patient’s death, results from the high performance thin layer chromatographic (HPTLC) method of analysis of the deceased’s viscera showed the presence of brucine in the liver and kidney. Quantification of brucine levels was not available.