Cardiotoxicity after accidental herb-induced aconite poisoning

Tai, Yoshiaki; Lau, CP; Young, K.; But, P.P.H.

doi:10.1016/0140-6736(92)92951-b

Cited by 186 publications

(105 citation statements)

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“…4 In another study of patients, described by Tai et al, 15 of 17 patients (90%) developed ventricular arrhythmia with a mortality rate of 10%. 1 An antidote for an Aconite intoxication is not available, nor is there any therapy with proven efficacy. Mechanical ventilation, inotropic support and resuscitation are usually necessary.…”

Section: Discussionmentioning

confidence: 99%

“…In several smaller studies various antiarrhythmic drugs, including amiodarone, flecainide, lidocaine and magnesium, have been suggested to be effective in treating ventricular arrhythmia. 1,3,4 Rationally, each of these drugs has potential actions to inactivate sodium channels or to reduce early after-depolarisation. However, efficacy data vary and appear to be contradictory.…”

Section: Discussionmentioning

confidence: 99%

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Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

Weijters¹,

Verbunt²,

Hoogsteen³

et al. 2008

NHJL

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Intoxication with Aconitum napellus is rare in our regions. Aconite alkaloids can cause ventricular arrhythmia by a prolonged activation of sodium channels. Because the margin of safety is low between the analgesic and toxic dose, intoxication is not rare when Aconite is used in herbal medicine. We present a case in which a 39-year-old male was accidentally intoxicated with Aconite. Even though no antidote or adequate therapy is available he was successfully resuscitated. (Neth Heart J 2008;16: 96-9.) Keywords: intoxication, aconite, aconitum, cardiotoxic, resuscitation A conitum napellus, commonly known as Aconite, Monkshood or Wolfsbane, is a herb with bluishpurple flowers (figure 1). It can be found throughout the world and is notorious for its toxicity. Most notably, the Roman emperor Claudius (41 to 54 AD) was murdered by his spouse Agrippina so her son Nero could then ascend the throne. It is thought that he was poisoned with Aconite. Even though it has known toxicity, Aconite roots are often sold freely and are commonly used in herbal medicine for treating musculoskeletal pain. However, the margin of safety between analgesic and toxic doses is very low. Therefore, intoxications are not extremely rare, especially in Southeast Asia. The most important cause of death due to an intoxication with Aconite is malignant ventricular tachyarrhythmia. We report an extraordinary case in which an accidental but life-threatening intoxication with Aconite occurred. Our patient recovered completely after prolonged resuscitation. Case reportA 39-year-old male with no medical history was admitted to our emergency department with collapse and signs of food intoxication. Less than two hours before, he had eaten a homemade salad of canned tuna and herbs from his own garden. After ingestion he became unwell with sweating and he developed paresthesiae in both his hands and tongue. Later he experienced nausea, vomited and had profound diarrhoea. Shortly before his admission he had collapsed once, and spontaneously regained consciousness. When he was first seen by paramedics, his blood pressure was unrecordable and ECG showed a broad complex tachycardia.When admitted to our emergency department we saw an ill, sweaty man who was still conscious. He told us that he had ingested more than 100 g of a kind of herb, which our patient believed to be celery. He had never eaten this before and it was unclear whether the ingested herb could be digitalis. At this moment he experienced dizziness and nausea. He had no complaints of chest pain. There was no history of intoxication with either nicotine, alcohol or any drugs. In his family there were no cases of sudden cardiac death; his father had undergone a percutaneous coronary intervention at the age of 64 years.The ECG showed a monomorphic ventricular tachycardia with a frequency of 220 beats/min (figure 2). After five minutes this rhythm evolved into a polymorphic ventricular tachycardia and subsequently ventricular fibrillation. Resuscitation was initiated immediately including intubatio...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

Weijters¹,

Verbunt²,

Hoogsteen³

et al. 2008

NHJL

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“…The ingredients can be quite difficult to determine, since each Chinese herbalist has his/her own recipe. Aconite, an herbal derivative of Fu Zi, is the commonest cause of adverse effects among Chinese herbal preparations, 10 however it is not always easy to determine which of a possible 19 different herbs in a mix is at fault. A case of aconite-related left ventricular failure from Chinese herbal medicine in a patient with aortic regurgitation has been reported.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 99%

Herbal medicine use is frequent in ambulatory surgery patients in Vancouver Canada

Lennox

Henderson

2003

Can J Anesth/J Can Anesth

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“…Fluorescence microscopy showed a singly labeled surface as well as a doubly labeled surface (Fig. 5D) (7); meningoencephalocele with Tripterygium wilfordii (8); cardiotoxicity with Aconitum rootstocks (9); valvular heart disease with Stephania tetrandra and others (10); aplastic anemia (ll); pulmonary embolism; thromboembolism (12); and urothelial cancer (13). Although Chinese herbs have been linked to disease in manyorgans, no report has suggested a relationship between Chinese herbs and bone disease.…”

Section: Case Reportmentioning

confidence: 99%

Chinese Herbs and Bone Disease

et al. 2003

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Wetreated a patient with an unusual bone disease at least partly associated with Chinese herbs. Seven years after 65-year-old man had begun to consume Chinese herbs, multifocal osteoarthralgias were noted, and the patient was hospitalized for renal dysfunction (serum creatinine, 2.8 mg/dl; urea nitrogen, 19 mg/dl). Fanconi syndromealso was apparent. Arenal biopsy specimen showed tubulo-interstitial fibrosis. Chinese herbs were discontinued and prednisolone was started, but bone and joint pain as well as renal function gradually worsened. Four years later, creatinine was 9.0 mg/dl and alkaline phosphatase was 571 IU//. As bone scintigraphy revealed localized asymmetric lesions, Paget's disease of bone was suspected at first. However, neither osteosclerosis nor hypertrophy was seen in radiographs. Based on a bone specimen histology we diagnosed as mixed-type renal osteodystrophy including osteomalacia and osteitis fibrosa. Mosaic pattern of cement lines was not present.This case was not compatible with either Paget's disease or typical renal osteodystrophy as seen in dialysis patients. Etidronate disodium was effective in alleviating bone symptoms. The patient's bone disorder may be a new disease at least partly related to Chinese herbs independently of nephropathy. (Internal Medicine 42: 345-350, 2003)

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Cardiotoxicity after accidental herb-induced aconite poisoning

Cited by 186 publications

References 5 publications

Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

Herbal medicine use is frequent in ambulatory surgery patients in Vancouver Canada

Chinese Herbs and Bone Disease

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