Abstract
To the Editor.— Recently, a 24-year-old woman was admitted to our emergency ward in profound metabolic acidosis. This was associated with tonic seizures that ultimately proved to be a result of pure strychnine poisoning. The initial pH was 6.57 (checked and rechecked); Po 2 ,140 mm Hg; and Pco 2 , 18 mm Hg. Blood lactate level was 177 mg/100 ml (normal, 0 to 16). Subsequent pH values were 6.70, 6.95, 7.15, and 7.37, giving sodium bicarbonate; ultimately, 35 ampules (each containing 50 ml of 50 mEq sodium bicarbonate 8.4%) were administered intravenously over a 90-minute period. The patient was discharged four days later without sequelae. I have been unable to find reports of this degree of acidosis associated with survival. I thought this case might prove of interest.
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