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

Abstract

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...

Stir Fry with a Side of Extracorporeal Membrane Oxygen: Management of Cardiogenic Shock Secondary to Unintentional Aconitine Ingestion

“…6 In North America, where Aconitum use as a traditional medicine is much less common, aconitine toxicity is rare and occurs most often due to ingestion of the wild plant after misidentification. [7][8][9] There have been several recent instances of individual or grouped poisonings of a specific genus, Aconitum, reported publicly in Canada. Most notably, over a dozen individuals were exposed to aconitine via a spice product at a restaurant in Markham, Ontario, in September 2022.…”

Aconite Poisoning and Monkshood

“…44 There are few clinical data on the most effective antiarrhythmic agent for ventricular dysrhythmias during aconite poisoning. Cardiovascular collapse and ventricular dysrhythmias represent the greatest risk to life, and prolonged cardiopulmonary resuscitation may be necessary for survival of severely intoxicated patients.…”

Aconite poisoning presenting as hypotension and bradycardia

“…1 Secondly, the public may mistake the garden and mountain monkshood (A. napellus) for some edible plants. 2 The principal toxic ingredients (aconitine, mesaconitine, hypaconitine and other C 19 -diterpenoid alkaloids) are most abundant in the roots and root tubers. 3 Raw aconite roots are extremely toxic and must be processed to reduce the alkaloid content before use.…”