aconitine and Poisoning

Both "chuanwu", the main root of Aconitum carmichaeli, and "caowu", the root of A kusnezoffii, are believed to possess anti-inflammatory, analgesic and cardiotonic effects and have been used in Chinese materia medica mainly for the treatment of musculoskeletal disorders. They contain the highly toxic C19 diterpenoid alkaloids of aconitine, mesaconitine and hypaconitine. After ingestion, patients may present with signs and symptoms that are typical of aconitine poisoning. Death may occur from ventricular arrhythmias, which are most likely to occur within the first 24 h. Management of aconitine poisoning is essentially supportive. There are no adequate studies in humans to indicate the most effective treatment of the ventricular arrhythmias. All clinicians should be alerted to the potential toxicity of "chuanwu" and "caowu".

Topics: Aconitine; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Drugs, Chinese Herbal; Female; Heart Ventricles; Hong Kong; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Poisoning; Retrospective Studies; Sodium Channels

某日，7名人员在某酒店用餐饮酒过程中出现不同程度的头晕、呕吐症状，怀疑食物中毒。经办案民警调查后发现，所涉及人员均饮用过某不明药酒，药酒中含有乌头样植物块茎。当地市场监督管理局提供现场发现的剩余药酒（棕色液体，1号检材）及块茎浸泡液（2号检材）送本鉴定中心进行检验鉴定。.

Topics: Aconitine; Chromatography, High Pressure Liquid; Humans; Poisoning

Due to a mix-up an older couple (69 years and 71 years) ate a meal with herbs from their garden that contained leaves of monkshood (Aconitum napellus). The monkshood plants grew close to the herbs in their garden. Both patients developed the typical symptoms of aconitine poisoning with paresthesia, hypotension and bradycardia. Over the course of time both developed cardiac arrhythmia with ventricular extrasystoles and required monitoring on the intensive care unit (ICU). The husband was more severely affected and needed catecholamines for successful treatment of hypotension (70/40 mmHg) and bradycardia (45 bpm). The toxicological analysis of the patients' serum taken 3.5 h after ingestion led to the detection of 1.8 ng/ml and 2.0 ng/ml aconitine, respectively. The patients were discharged in good general condition after 1 and 2 days, respectively. Monkshood (Aconitum napellus) is one of the most toxic native plants that can also be found in gardens due to its popularity as an ornamental plant. All parts of the plant contain toxic diterpenoid alkaloids, such as aconitine. Aconitine causes persistent activation of the fast voltage-gated sodium channels resulting in severe cardiac and neurological toxicity. Treatment of aconitine-induced ventricular arrhythmias is challenging as they are often refractory to electrical cardioversion and antiarrhythmic drugs.. Aufgrund einer Verwechslung aß ein älteres Ehepaar eine Mahlzeit mit Kräutern aus ihrem Garten, die Blätter des Blauen Eisenhuts (Aconitum napellus) enthielt. Die Eisenhutpflanzen wuchsen im Garten in der Nähe der Kräuter. Beide Patienten entwickelten die typische Symptomatik einer Aconitinvergiftung mit Parästhesien, Hypotonie und Bradykardie. Im Verlauf hatten beide Herzrhythmusstörungen mit ventrikulären Extrasystolen und mussten intensivmedizinisch behandelt werden. Katecholamine wurden bei dem stärker betroffenen Ehemann erfolgreich eingesetzt. Bei der toxikologischen Untersuchung des Serums, entnommen 3,5 h nach der Mahlzeit, wurden 1,8 ng/ml bzw. 2,0 ng/ml Aconitin nachgewiesen. Die Patienten konnten nach einem bzw. 2 Tagen in gutem Allgemeinzustand entlassen werden.

Topics: Aconitine; Aconitum; Arrhythmias, Cardiac; Humans; Levisticum; Plant Leaves; Poisoning

Aconitine is a highly toxic diterpenoid alkaloid, produced by plants of the Aconitum genus, that is still used in Chinese herbal medicines. Aconitine poisoning remains common in China and other parts of Asia.. A 48-year-old man received a diagnosis of aconitine poisoning after ingesting herbal medicinal wine made with caowu, which is made from Aconitum kusnezoffii roots, and was admitted to our hospital' s emergency department. Electrocardiography and thoracoabdominal computed tomography showed cardiovascular toxicity from aconitine poisoning along with polycystic renal hemorrhaging. Because the arrhythmia was not controlled with lidocaine, blood purification with a reduced dosage of heparin was performed to treat the arrhythmia and to avoid increasing the bleeding of the polycystic renal hemorrhage. The patient recovered from aconitine poisoning and polycystic kidney hemorrhage.. This case significantly advances our understanding of hemoperfusion with reduced heparin for the treatment of ventricular arrhythmia caused by aconitine poisoning.

Topics: Aconitine; Electrocardiography; Hemorrhage; Herbal Medicine; Humans; Male; Middle Aged; Poisoning; Polycystic Kidney Diseases; Tomography, X-Ray Computed

Topics: Aconitine; Aged; Humans; Male; Poisoning

Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported.. A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis.. Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.

Topics: Aconitine; Creatine Kinase; Diagnosis, Differential; Drugs, Chinese Herbal; Echocardiography; Humans; Male; Middle Aged; Myocardial Infarction; Plant Extracts; Poisoning; Powders; Technetium Tc 99m Pyrophosphate; Troponin I

Topics: Aconitine; Aconitum; Cardiopulmonary Resuscitation; Charcoal; Female; Hemoperfusion; Humans; Male; Middle Aged; Poisoning

The Bible contains several interesting contributions to the history of neurology, as is the case of the High Priest Alkimos, who died suddenly in 159 BC. He was regarded as a stereotypical stroke victim for a long time. The reports on his death in the Septauginta and the later 'Jewish Antiquities' of Flavius Josephus present some typical symptoms of stroke (collapse, loss of speech and death within a short time), but they also describe severe pains, which are very unusual among patients with stroke. Similar symptoms can be found in the case of the Roman emperor Claudius, who was poisoned by his spouse Agrippina. It was thought that she used aconitine, an ingredient of the monkshood plant (Aconitum napellus L.), which imitates an apoplectic insult, but also causes vehement pains. It was therefore possible that something similar had happened to Alkimos, as aconitine was a common poison in ancient times and the surroundings of his death may confirm the suspicion. Reigning during a time of great upheaval, Alkimos was able to maintain his high office chiefly because of the help of the Seleucides. He has just begun construction work on the temple of Jerusalem, an order, which was regarded as a sacrilege by his foes. This impression was enhanced by his subsequent illness which could be considered as a divine punishment.

Topics: Aconitine; Bible; Famous Persons; History, Ancient; Humans; Israel; Male; Poisoning; Rome

Topics: Aconitine; Aged; Emergencies; Female; Homicide; Humans; Male; Middle Aged; Plants, Toxic; Poisoning; Shock

Described here is a fatal case of accidental aconitine poisoning following the ingestion of aconite, Torikabuto, mistaken for an edible grass, Momijigasa. A 61-year-old man developed symptoms of nausea, diarrhea, and discomfort of the body about 2 h after the ingestion and was taken to an emergency room. Resuscitation and antiarrhythmic drugs were ineffective, and ventricular tachycardia and fibrillation developed and lasted for 6 h. He was transferred to a coronary care unit and complete sinus rhythm was obtained on an electrocardiogram 30 h after his admission. The patient fell into a coma and died of brain edema diagnosed by CT on the 6th day. Consent for autopsy was denied by the family but was given for gas chromatography/selected ion monitoring (GC/SIM) to analyze the toxicity of aconitine alkaloids in the blood and the urine. Only a faint amount of jesaconitine was detected, while aconitine, mesaconitine and hypaconitine were not detectable in the blood 24 h after ingestion. On the other hand, aconitine and its related alkaloids such as mesaconitine, jesaconitine, and hypaconitine were clearly detected in the urine.

Topics: Aconitine; Chromatography, Gas; Fatal Outcome; Forensic Medicine; Humans; Ion-Selective Electrodes; Male; Middle Aged; Plants, Edible; Poaceae; Poisoning

Traditional Chinese medicines often contain 'chuanwu' and 'caowu', the roots of certain Aconitum species which are thought to have an anti-inflammatory effect in many conditions. Excessive amounts of these materials, which contain diterpene alkaloids particularly aconitine, can produce toxic effects and occasional fatalities.. This study was conducted to document the adverse effects related to these herbal medicines which resulted in hospital admission and to determine the outcome in these patients.. A retrospective survey was conducted of patients admitted to the Prince of Wales Hospital, Hong Kong with suspected adverse effects from Chinese herbal medicines containing chuanwu or caowu over a two year period from 1989 to 1991.. Eight patients were identified with features of mild to moderate intoxication including nausea and vomiting, paraesthesiae or numbness in the mouth and extremities, hypotension and ventricular extrasystoles. The management of aconitine poisoning is essentially supportive and in-hospital observation with ECG monitoring should be continued for at least 24 hours because of the risk of cardiovascular collapse and ventricular arrhythmias. The medical profession and general public should be alerted to the potential toxicity of these herbs and their usage should be controlled by legislation in Hong Kong as it is in some other countries.

Topics: Aconitine; Adult; Drugs, Chinese Herbal; Female; Hong Kong; Humans; Male; Middle Aged; Poisoning; Retrospective Studies

A case of aconitine poisoning following the ingestion of 'chuanwu', the main root of Aconitum carmichaeli, and 'caowu', the root of Aconitum kusnezoffii is described. A 35-year-old man became unwell about 90 minutes after ingesting these herbs and his symptoms lasted for about two days. In addition to the typical gastrointestinal (nausea and vomiting) and neurological (generalized weakness, numbness and paraesthesia) features of aconitine poisoning, there was evidence of cardiotoxicity (hypotension and ventricular ectopics). Management of such patients should include measures to enhance elimination and close monitoring for cardiotoxicity. Legislation controlling the use of such herbs should be considered.

Topics: Aconitine; Adult; Drugs, Chinese Herbal; Heart; Humans; Male; Poisoning

Topics: Aconitine; Aconitum; Arrhythmias, Cardiac; Cardiac Complexes, Premature; Electrocardiography; Humans; Poisoning; Toxicology

Topics: Aconitine; Aconitum; Humans; Poisoning

Topics: Aconitine; Aconitum; Humans; Poisoning