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Route of Absorption
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Onset of Symptoms After Exposure
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oral
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15 to 30 minutes
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inhalation
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as soon as 5 minutes
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Clinical findings:
(1) heightened sense of awareness, with sense of apprehension
(2) muscle spasms with hypersensitivity to stimuli
(3) generalized hyperreflexia
(4) severe convulsions that may be precipitated by minimal stimuli
(5) clear sensorium during and after convulsions (no post-ictal confusion)
(6) hypoxia from respiratory insufficiency
(7) hyperthermia
(8) lactic acidosis
Features shared with tetanus:
(1) opisthotonus, mimicing tetanus
(2) facial muscle spasm with risus sardonicus
Muscles spasms may result in acute rhabdomyolysis, which can produce acute renal failure.
Causes of death may include:
(1) respiratory arrest following spasm of respiratory muscles
(2) cardiac arrest
If the person survives 5 hours then the prognosis is typically good.
