Aconite Poisoning: A Case Report (original) (raw)
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Intentional ingestion of aconite: Two cases of suicide
Forensic Science International: Reports, 2020
Aconitum plants have long played a major role in traditional Asian medicine and cuisine. The roots are often eaten or used to prepare a soup for culinary or traditional medicinal reasons. Thus, many cases of aconitine poisoning have been reported in China and nearby countries. However, only few cases have been described in Europe. We present two unrelated cases of aconitine poisoning. A 44 year and a 56 year old man were found dead in their beds. In both cases, residual plant material was found in close proximity to the body. The autopsies revealed gastric contents interspersed with plant components, blood congestion, hemorrhages in the lung tissue, lung edema and brain edema. Additionally, we found fine-vacuolar fat-negative intracytoplasmatic transformation of hepatocytes. Aconitine was detected in all analyzed samples (blood, urine, gastric content and kidney) and quantified in femoral blood with 86.2 mg/L (case 1) and 2.3 mg/L (case 2), respectively. In both forensic cases, the scenery suggested a suicidal ingestion of Aconitum plant material.
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
Reversible intraventricular conduction defect in aconite poisoning: A Case report
Health Renaissance, 2017
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 Health Renaissance 2015; 13 (1): 108-111
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
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.
A Case of Fatal Aconitine Poisoning by Monkshood Ingestion
Journal of Forensic Sciences, 2008
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 lg ⁄ 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.
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.
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.
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...