Intoxication par vératre : description d’un cas grave et identification des alcaloïdes contenus dans la plante

Abstract

ObjectiveConfusion between white veratrum and gentiana can lead to severe poisoning. We report the analytically documented case of a 34-year-old woman who ingested a ``homemade'' beverage prepared by maceration of a plant initially identified as gentiana. Clinical caseThe Lyon Poison Control Center was contacted by a patient reporting digestive disorders, dizziness, headache, visual hallucinations and sensation of heat with excessive sweating. The symptoms appeared after the ingestion of a glass of wine and a maceration based on a picked plant believed to be gentiana. The patient was hospitalized and presented arterial hypotension associated with bradycardia. Treatment with atropine and intravenous fluid allowed the recovery of the patient. Material and methodsThe plant-based beverage ingested by the patient was analyzed by the liquid chromatography screening method coupled to high resolution mass spectrometer (LC-HRMS). A hydroalcoholic solution of yellow gentiana was analyzed as a control. ResultsSeveral alkaloids were initially identified in the solution ingested by the patient because they were present in the screening database: jervine, cevadine and solanidine. Other characetristic alkaloids characteristic of veratrum were also found (veratramine, protoveratrine A and cyclopamine). DiscussionThe use of a screening method by CL-SMHR allowed the identification of alkaloids characteristic of white veratrum in the maceration ingested by the patient. These results and the patient's symptoms confirmed the confusion between gentiana and veratrum.