Reversible intraventricular conduction defect in aconite poisoning: A Case report (original) (raw)
Related papers
Reversible intraventricular conduction defect in aconitine poisoning
Singapore medical journal, 2009
Aconitine and related alkaloids found in the Aconitum species are highly cardiotoxic and neurotoxic. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Soaking and boiling during processing will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias.
Bidirectional Tachycardia Induced by Herbal Aconite Poisoning
Pacing and Clinical Electrophysiology, 1992
TAI, Y.‐T., et al.: Bidirectional Tachycardia Induced by Herbal Aconite Poisoning. This report details the clinical, electrocardiographic, and electropharmacological characteristics of an unusual case of bidirectional tachycardia induced by aconites present in a Chinese herbal decoction consumed by a previously healthy subject. The tachycardia showed marked susceptibility to vagotonic maneuvers, cholinesterase inhibition, and adenosine triphosphate. The incessant nature of the tachycardia, rapid recurrence after transient suppression, and failure to respond to direct current cardioversion suggested an automatic tachycardia mechanism consistent with known data on the cellular electrophysiological mechanism of aconitine‐mediated arrhythmogenesis. A fascicular or ventricular myocardial origin of the tachycardia with alternating activation patterns, or dual foci with alternate discharge, appeared most plausible. The rootstocks of aconitum plants have been commonly employed in traditiona...
Forensic Science International, 1994
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 resuscitation; 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. SSDf 0379-0738(94)01509-4 P. Dickens et al. /Forensic Sri. ht. 67 (1994) 55-58
Distribution of Aconitum alkaloids in autopsy cases of aconite poisoning
Forensic Science International, 2013
Aconite is a well-known toxic-plant of the genus Aconitum in the Ranunculaceae family, and grows widely in Northern Asia and North America. In Japan, there are about 30 species. The chemical structures of Aconitum alkaloids are shown in Fig. 1. Aconitines are the causative agents of aconite poisoning, since the toxicity of aconitines is much stronger than that of other alkaloids [1]. The LD50 value of aconitine in mice is reported to be 1.8 mg/kg when administered orally [1], and the lethal dose of aconitine for humans is estimated to be 1-2 mg [2,3]. Since the toxicity of aconitine is reduced by hydrolysis [1], benzoylaconines and aconins (hydrolysis products of aconitine) have low toxicities. Hydrolysis products include both biotransformation products and non-enzymatic hydrolysis products, and are contained in both aconite, and in aconite water extract. In addition, higher hydrolysis rates have been observed at higher temperatures at pH 7.4 [4]. The content and component ratio of aconitines in aconite plants varies with species, parts of the plant, and seasons [5-8]. Aconite has been used in case of suicide and homicide because of its high toxicity. Most reported cases of aconite poisoning have occurred in Japan and China [9-14], and various toxic symptoms have been observed, with arrhythmia the most typical symptom. Autopsy cases of aconite poisoning have no specific findings, and few studies of the distribution of Aconitum alkaloids in tissues have been reported [15,16]. Information on the body distribution of Aconitum alkaloids might be useful to elucidate various actions of aconite alkaloids. In this report, we describe the distribution of Aconitum alkaloids in three autopsy cases. 2. Case histories All three cases were of suicide by aconite poisoning. Case 1: a male in his fifties was found dead in his home. His wife, a psychiatric outpatient, was transported to the critical care center by ambulance. There were some aconites in their home, and they had eaten some leaves mashed in a mixer. There was no evidence
Aconite Poisoning: A Case Report
Annapurna Journal of Health Sciences
Aconite is the well-known toxic plant as well as valuable drug since decades. Most of the intoxications are accidental whereas suicidal attempt is rather rare after ingestion. This case report is about three persons who landed in our emergency department after consuming Aconite accidentally as an herbal medicine. Two of them were managed immediately while one was declared dead on arrival.
A perfect refractory electrical storm by acute toxicity of accidental aconitine intake
Emergency Care Journal
A 51-years-old male presented with drooling, hematemesis and diarrhea in emergency department after accidental ingestion of homemade aconitine tincture. Examination revealed shock and initial ECG showed atrial fibrillation. The patient suddenly developed a pulseless wide QRS complex tachycardia requiring resuscitation maneuvers. The rhythm varied from monomorphic ventricular tachycardia to torsade de point to ventricular fibrillation. Repeated direct-current cardioversions were unsuccessful. After intravenous electrolyte correction and anti-arrhythmic drugs administration, a last direct-current shock was finally successful. Bradycardia and ventricular excitability persisted over 12 hours with gradual normalization. Patient was discharged in normal sinus rhythm without any medication and on follow-up he was totally asymptomatic. With the increasing popularity of traditional medicine, clinicians should be alerted to the risk of herbal substances with low margins of safety like Aconitu...
Overdose effect of aconite containing Ayurvedic('Mahashankha Vati')
There are chances that the use of larger than recommended dose of Ayurvedic medicines containing aconite can produce drug reactions. Vatsanabha (Aconitum ferox Wall.) is a very well-known ingredient of Ayurvedic formulations and is prescribed as an antipyretic, analgesic, anti-rheumatic, appetizer and digestive. The recommended dose of purified Vatsanabha (A. ferox Wall.) root is 15 mg. We present a case of hypotension and bradycardia due to aconite poisoning caused by overdosing of an Ayurvedic medicine (Mahashankha Vati), which was primarily managed by Ayurvedic treatment.
Overdose effect of aconite containing ayurvedic medicine (′Mahashankha Vati′)
International Journal of Ayurveda Research, 2010
It is a common misconception among the public that Ayurvedic medicines are safe and devoid of adverse reaction. More than 70% of the total sales of Ayurvedic drugs are over-the-counter (OTC), thus leading to the use of Ayurvedic medicines without prescription, guidance and oversight of Ayurvedic physicians. [1] Many poisonous plants like Ahiphena (Papaver somniferoum Linn.), Bhanga (Cannabis sativa Linn.), Dhattur (Dhatura metel Linn.), Karavira (Nerium indicum Mill.), Kupilu (Strychnos nuxvomica Linn.f.), Langali (Gloriosa superba Linn.), Vatsanabha (Aconitum ferox Wall.), Jayapal (Croton tiglium Linn.), etc. have been used in Ayurveda medicine. [2] According to Ayurveda, "even a strong poison can become an excellent medicine if administrated properly; on the other hand, even the most useful medicine can act like a poison if handled incorrectly". [3] Unexpected adverse reactions can occur due to accidental use of a poisonous herb/medicine/decoction by the patient, misidentification of herbs so that a toxic herb is mistaken to be a harmless variety, improper purification of the poisonous ingredients, overdose, irrational prescription, self-medication and drug interaction with allopathic drugs. Aconite-based Ayurveda medicines are commonly used by Ayurvedic physicians and traditional practitioners/folk healers in primary healthcare. The most common aconitebased medicinal plant Vatsanabha (A. ferox Wall.) is used in Ayurveda as an antipyretic, analgesic, anti-rheumatic, appetizer and digestive.
Bidirectional Ventricular Tachycardia Induced by Aconiti Lateralis Radix Praeparata: A Case Report
Journal of Medical Cases, 2016
Herbal soups are important therapeutic agents used in Chinese medicine for various conditions. Therefore, aconitine-induced poisoning may be frequently encountered in practice among Chinese communities. However, there is limited information regarding life-threatening bidirectional ventricular tachyarrhythmia induced by aconitine intoxication and its management. We present the case of a 48-year-old woman with bidirectional ventricular tachyarrhythmia attributed to the use of processed Fuzi and describe the successful therapeutic approach adopted in this case.