Aconitine Poisoning Research Articles

Type II bidirectional ventricular tachycardia in a patient with myocardial infarction

A 84-year-old man presented to the emergency department complaining of chest pain and palpitations. He had no history of coronary artery disease. The 12-lead electrocardiography showed bidirectional ventricular tachycardia (BVT). Coronary angiography revealed severe mid left anterior descending and mid left circumflex lesions. The BVT, in this case, was most likely due to myocardial ischema. The ethiology of published BVT cases are most commonly digitalis toxicity and rarely herbal aconitine poisoning, hypokalemic periodic paralysis, cathecolaminergic VT, myocarditis, and Anderson-Tawil syndrome. The patient had neither of these underlying conditions. To the best of our knowledge and research in the literature, there was no report of bidirectional VT in the patients with myocardial infarction.

A Case of Fatal Aconitine Poisoning by Monkshood Ingestion*

Accidental aconitine poisoning is extremely rare in North America. This report describes the confirmation of a case of accidental aconitine poisoning using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The case involved a 25-year-old man who died suddenly following a recreational outing with friends where he consumed a number of wild berries and plants including one that was later identified as Monkshood (Aconitum napellus). Postmortem blood and urine samples were available for analysis. All routine urine and blood toxicology screens were negative. The LC-MS/MS method allowed sensitive quantification of aconitine, the main toxin in A. napellus, and showed 3.6 and 149 microg/L in blood and urine, respectively. These concentrations were similar to that reported in other aconitine-related deaths. This case illustrates the dangers of consuming unidentified plants, and documents concentrations of aconitine in blood and urine in a fatal case of A. napallus-related poisoning.

Aconitine involvement in an unusual homicide case

We describe a homicide complicated by an aconitine poisoning, which was initially thought to be a strangulation case. Routine toxicological analyses demonstrated only a small amount of alcohol in the blood and the urine. The case could not be clarified until 5 years after the event. A new element in the investigation made the wife the prime suspect, and finally, after thorough interrogation, she confessed her crime. She had mixed a decoction of three plants of Aconitum with red wine. Additional toxicological analyses, using the liquid chromatography-tandem mass spectrometry (LC-MS-MS) technique demonstrated 810 ng/ml of aconitine in urine, 6.5 ng/g in liver and 1.3 ng/g in the kidneys. Even though aconitine poisoning is still rare in Europe, it should be taken into account in suicides and homicides, particularly in unclarified cases.

A Multidisciplinary Approach to the Toxicologic Problems Associated with the Use of Herbal Medicines

In Hong Kong, a multidisciplinary team consisting of a pharmacist, a chemical pathologist, a scientific officer, and a physician has jointly provided an advisory service on herbal safety to healthcare professionals of all public hospitals since August 2000. This paper reports the first 2 years of experience of this team to emphasize the importance of a multidisciplinary approach to herbal poisoning. Twenty referrals received from the public hospitals from August 2000 to June 2002 were reviewed. The diagnosis of herbal toxicity was made after consideration of the temporal relationship between exposure to the herb and the occurrence of the adverse event and the exclusion of other causes. The causal relationship was seen as much stronger if the herb's pharmacological effects could fully explain the adverse event, if there were similar previous reports, and if the toxicological analysis findings were supportive. In 10 patients, the adverse events were deemed unlikely to be related to the use of herbal medicines. In 3 patients, it was concluded that the adverse events were possibly related to the use of herbal medicines. In 7 patients, the causal relationship was seen to be much stronger because the adverse events in these patients simply reflected the pharmacological effects of the herbs consumed and specific toxic ingredients were isolated from herbal residues and patients' urine or serum. The clinical problems arising from the use of herbal medicines included the Aristolochia species causing acute renal failure (n = 1), aconite roots causing aconitine poisoning (n = 2), the Datura species causing anticholinergic poisoning (n = 1), and "yulan" (Stephania sinica) causing tetrahydropalmatine poisoning (n = 3). The 4 patients with acute renal failure and tetrahydropalmatine poisoning received these toxic herbs, which were not listed in the prescriptions, as a result of poor dispensing practice or for other reasons. Toxicological problems associated with the use of herbal medicines are complex and may be easily overlooked. A multidisciplinary team of experts should be made available to provide advice to frontline healthcare professionals.

Clinical features and management of herb-induced aconitine poisoning

Study objective We define the potential sources, clinical manifestations, and treatment of aconitine poisoning. Methods The database of the National Poison Center in Taiwan was retrospectively searched for the diagnosis of aconitine poisoning for 1990 to 1999. The reasons for taking the aconite roots, the clinical features, management, and possible predisposing factors were noted. Results A total of 17 cases occurred and consisted of 9 men and 8 women aged 30 to 70 years. Thirteen patients ingested aconite roots as treatment for rheumatism and wounds. Two patients volunteered to test the effects of aconite roots in a drug study. Two patients accidentally ingested the aconite roots. After a latent period of 10 to 90 minutes, patients developed a combination of neurologic (n=17), cardiovascular (n=14), gastrointestinal (n=9), and other (n=5) features typical of aconitine poisoning. Four patients developed ventricular tachycardia. All patients received supportive treatment. Patients with ventricular tachycardia were also treated with charcoal hemoperfusion. All patients made a complete recovery. Conclusion Life-threatening ventricular tachycardia can occur after the consumption of aconite roots. The risk is higher with inadequately processed aconite roots, large doses, or tincture preparations. With increasing popularity of herbal medicines, herb-induced aconitine poisoning may also be seen in Western countries.

Incidence of herb-induced aconitine poisoning in Hong Kong: impact of publicity measures to promote awareness among the herbalists and the public.

In Hong Kong 'chuanwu' (the main root of Aconitum carmichaeli) and 'caowu' (the root of Aconitum kusnezoffii) are used by herbalists to treat patients with various musculoskeletal disorders. These aconite roots contain aconitine, mesaconitine and hypaconitine, which are neurotoxins and cardiotoxins. During 1989 to 1991, 31 patients were treated in public hospitals because of poisoning by aconite roots and there were two deaths from ventricular arrhythmias. In late 1991, healthcare officials together with cardiologists held a press conference to warn the public, healthcare professionals and herbalists of the potential toxicity of aconite roots. The risk of ventricular arrhythmias and the need for urgent medical attention were highlighted. An information leaflet was also sent to hospital doctors. Since 1992, the topic was covered periodically in the local newspapers, medical journals and continuing medical education programmes. The objective of this study was to assess the impact of these publicity measures on the incidence of herb-induced aconitine poisoning in the New Territories East, based on the number of admissions to the Prince of Wales Hospital. During 1989 to 1993 and 1996 to 1998, all patients admitted to our medical wards because of herb-induced aconitine poisoning were identified by on-going surveillance of medical patients, searching our computerised medical record system and reviewing reports received by the 24-hour Drug and Poisons Information Bureau. The number of hospitalisations due to aconitine poisoning markedly decreased from four to six per year in 1989 to 1991 to one to two per year in 1992 to 1993. The annual incidence of aconitine poisoning showed a marked decrease from 0.49 to 0.69 [overall 0.60, 95% confidence intervals (CI) 0.34 to 0.99] to 0.10 to 0.22 (overall 0.16, 95% CI 0.03 to 0.46) per 100,000 population (p = 0.024). During 1996 to 1998, herb-induced aconitine poisoning remained uncommon, with zero to two hospital admissions per year or an annual incidence of zero to 0.33 (overall 0.17, 95% CI 0.05 to 0.43) per 100,000 population (p = 0.016). It is possible that the herbalists could have used smaller doses of 'chuanwu' and 'caowu' than before. Patients could be more compliant with the instructions on how to prepare the herbal decoction at home. However, our experience suggested that publicity measures to promote awareness, among the herbalists and the public, may reduce the incidence of poisoning due to toxic herbs such as aconite roots.

Cardiovascular aspects of aconitine poisoning

Background and Objectives:The Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. Materials and Method:During a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. Results:All patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. Conclusion:Aconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins. (Korean Circulation J 2000;30(7):855-860)

Fatal accidental aconitine poisoning following ingestion of Chinese herbal medicine: a report of two cases

Two Hong Kong Chinese adults were prescribed aconitine-containing herbal preparations by Chinese herbal practitioners for relief of minor musculoskeletal pain. After ingestion both quickly developed ventricular tachycardia followed by ventricular fibrillation and cardiac arrest refractory to resuscitaion; death in both cases occurred within 12 h of ingestion. Neither had a history of cardiac disease. Coroners' autopsies showed no significant macroscopic or microscopic findings, with no evidence of ischaemic heart disease or other cardiac disease. Toxicological examination of stomach contents showed a trace of hydrolysed aconitine in one case but was negative in the other. Analysis of the herbal preparations consumed, however, confirmed the presence of the aconitine-containing herbs in quantities greatly in excess of the maximum recommended in the P.R. China pharmacopoeia. Both patients therefore consumed an accidental overdose of aconitine, which has a narrow safety margin between therapeutic analgesic effect and its known cardiotoxic effect. These particular herbal medicines are controlled substances in mainland China and Taiwan, but no controls on their dispensing exist in Hong Kong. Together with reported non-fatal cases of aconitine poisoning, these cases emphasise that legal controls of the dispensing and use of aconitine-containing herbal preparations are necessary in Hong Kong.

A near lethal case of combined strychnine and aconitine poisoning

The successful supportive management of an acute combined strychnine and aconitine poisoning is described. The clinical features including initially resistant ventricular fibrillation and biochemical findings are reported. Occurrence, signs, symptoms, mechanisms of action of both strychnine and aconitine and treatment particularly with regard to the life-threatening arrhythmia induced by aconitine are briefly reviewed.

A CASE OF ACONITINE POISONING CAUSING CARDIAC COLLAPSE

This case of aconitine poisoning is reported primarily to acquaint physicians with the possibility of its unsuspected occurrence. There are probably other cases of mild and severe aconitine poisoning throughout the United States which are being overlooked. Aconitine is a drug that finds little usefulness nowadays and naturally does not enter the physician's mind. Records of aconitine poisoning in any form are unusual in modern medical literature. In my perusal of the literature back to 1883, I could find only three case reports of aconitine poisoning in man with specific mention of its effect on the heart. There were no recent cases. Also, this is apparently the only case in man in which electrocardiographic records were obtained. REPORT OF CASE E. O., a merchant, aged 31, weighing about 242 pounds (110 Kg.), drank at about 4 p. m. a small amount of whisky which he had purchased a few weeks

THE VIVISECTION BILL

THE failure of Mr.Reid's Vivisection Abolition Bill on April 4 affords cause of congratulation to all who are interested in science, although it is perhaps to be regretted that the Bill did not come to a “division” instead of being “talked out.” Scientific men must be pleased because one more attempt of ignorance to stop the pursuit of knowledge has been defeated. But, more than this, the failure of the Bill is a boon to all who care for their own health, for that of their families, and for the welfare of society at large. Had it passed it would not only have stopped all experiments in physiology, pathology, and pharmacology in this country, but it would have rendered impossible the detection of crime by the application of physiological tests. Had this Bill been law at the time of the trial of Lamson for poisoning by aconite, his conviction would have been impossible; for although chemical evidence pointed to aconite as the poison used, the tests for it were not sufficiently distinctive to have justified his conviction on chemical evidence alone, and it required to be corroborated by physiological evidence. This was afforded by the injection of the substance obtained from the stomach into some small animals. As these died presenting all the symptoms of aconitine poisoning, the chemical evidence was confirmed, and the poisoner was accordingly convicted.