Human Poisoning due to Delphinium species in the Himalayan Region of Nepal: A Case Report

Abstract

The Delphinium species herb, common name ‘Nirmasi’ in Nepal, is one of the community level flower herbs used as medicinal ingredients in various clinical problems in Manang District and other Himalayan parts of Nepal. Roots of the plants from the genus Delphinium have been used for a long time for headache, epilepsy, mania, paralysis, rheumatism, toothache, and various types of pain. However, many species of Delphinium are poisonous and look quite similar in morphology to the beneficial ones. As a result, accidental poisoning is common. Poisoning due to these plants results in symptoms due to gastric irritation, competitive neuromuscular blockade, and cardiotoxicity caused by various alkaloids present in them. We report here a case of poisoning due to Delphinium species ingestion presenting as hypotension and bradycardia managed successfully with symptomatic treatment.

Nirmasi (Delphinium) poisoning with salvoes of malignant ventricular arrhythmias in central Nepal: A case report

“…4 The mechanism of toxicity of this class of alkaloids is neuromuscular paralysis; they compete as post-synaptic inhibitors of the neurotransmitter acetylcholine, specifically, acting at the α 1 nicotinic sites in the mus-cle and brain, causing muscular fatigue, depressed respiration and other curare-like symptoms. 5,6 Our patient presented with complaints of dizziness with syncopal attack secondary to malignant ventricular arrhythmias and hypotension which could be the effect of such alkaloids competitively inhibiting the acetycholine at preganglionic sympathetic synapse blocking the sympathetic outflow to the heart. There has been no specific antidote noted for Delphinium poisoning in humans.…”

Ventricular tachycardia storm after accidental poisoning of delphinium species: a rare case report

“…Most of the wild flora of Nepal is rich in medicinal properties out of which Delphinium brunonianum has been popularly used for the treatment of many ailments like fever, headache, abdominal pain, jaundice, cough, toxin removal, and skin rashes. However, some species of Delphinium are toxic depending on the chemical constituents of the plant 2 . Tomassoni et al 7 reported the cardiotoxic nature upon consumption of Delphinium manifested as VT. Another study conducted in the Manang district of Nepal reported a case of hypotension and sinus bradycardia after ingestion of Delphinium species 2 .…”

“…However, some species of Delphinium are toxic depending on the chemical constituents of the plant 2 . Tomassoni et al 7 reported the cardiotoxic nature upon consumption of Delphinium manifested as VT. Another study conducted in the Manang district of Nepal reported a case of hypotension and sinus bradycardia after ingestion of Delphinium species 2 . The index case had accidental poisoning upon consumption of Delphinium manifesting from gastric upset to a severe form of cardiotoxicity that is ventricular storm.…”

“…The temporal relationship between the patient’s history of consumption of Delphinium and the development of the ventricular storm gives us an idea of the possible cardiotoxic nature of the Delphinium species. No specific antidote for Delphinium poisoning in humans has been identified to this date 2 , for which the patient had undergone aggressive abortive measures.…”

“…‘Nirmasi’, or ‘Nirmashi’, one of the commonly used medicinal herbs in Nepal, is a species that belongs to the genus Delphinium of the family Ranunculaceae of which more than 356 species are identified. Nirmasi is infamously used for fever, headache, abdominal pain, jaundice, epilepsy, cough, and skin rashes which may be attributed to its antimicrobial, anti-inflammatory, antineoplastic, antifeedant, and cholinesterase inhibition properties 1 , 2 . As studies have suggested, the substance responsible for the medicinal properties of Delphinium is diterpenoid alkaloids.…”