jesaconitine and Tachycardia--Ventricular

Two people out of three who accidentally ate boiled aconite leaves died in 2012. This was a typical case of aconite poisoning in Japan: Aconite (Aconitum spp.) was mistakenly collected instead of Anemone flaccida, an edible wild plant. The leaves of these plants are quite similar to each other. Chemical analyses of the aconite plant left at the scene suggested intake of a fatal amount of aconitine alkaloids by each person. The collector, who died, had missed the botanical differences between the two plants, even though he owned a wild plant guidebook. A. flaccida should be collected with its flowers in order to aid positive indentification and avoid aconite poisoning.

Topics: Aconitine; Aconitum; Adult; Aged; Chromatography, High Pressure Liquid; Fatal Outcome; Female; Heart Arrest; Humans; Male; Middle Aged; Plant Leaves; Shock, Cardiogenic; Tachycardia, Ventricular; Tandem Mass Spectrometry

Aconite poisoning was examined in five patients (four males and one female) aged 49 to 78 years old. The electrocardiogram findings were as follows: ventricular tachycardia and ventricular fibrillation in case 1, premature ventricular contraction and accelerated idioventricular rhythm in case 2, AIVR in case 3, and nonsustained ventricular tachycardia in cases 4 and 5. The patient in case 1 was given percutaneous cardiopulmonary support because of unstable hemodynamics, whereas the other patients were treated with fluid replacement and antiarrhythmic agents. The main aconitine alkaloid in each patient had a half-life that ranged from 5.8 to 15.4 h over the five cases, and other detected alkaloids had half-lives similar to the half-life of the main alkaloid in each case. The half-life of the main alkaloid in case 1 was about twice as long as the half-lives in the other cases, and high values for the area under the blood concentration-time curve and the mean residence time were only observed in case 1. These results suggest that alkaloid toxicokinetics parameters may reflect the severity of toxic symptoms in aconite poisoning.

Topics: Accelerated Idioventricular Rhythm; Aconitine; Aconitum; Aged; Area Under Curve; Arrhythmias, Cardiac; Biotransformation; Chromatography, High Pressure Liquid; Drugs, Chinese Herbal; Electrocardiography; Female; Half-Life; Humans; Male; Middle Aged; Severity of Illness Index; Tachycardia, Ventricular; Tandem Mass Spectrometry; Toxicology; Ventricular Fibrillation; Ventricular Premature Complexes