Aconitum poisoning

Substance

Aconitum 烏頭鹼

本草備藥:  

烏頭: 母. 川烏(四川) , 草烏(野生). 

附子: 附生者

側子: 連生者 

天雄: 形狀細長者

烏喙:形狀兩歧者

五物同出異名 

Common name or Trade name

今中醫中藥所使用附子為烏頭Aconitum carmichaeli Debx.的子根經中藥炮製切片而成

川烏為 烏頭Aconitum carmichaeli Debx.的乾燥母根

草烏為 北烏頭Aconitum kusnezoffii Reichb.的乾燥塊根。[1]

Involving system

-          Mechanism: aconite alkaloids are the fast voltage-gated sodium channel and cause persistent activation. [2]

 

Presentation

-          Altered mental status. [3]

-          Shock [3]

-          Cardiac arrhythmia. [3];

-       BVT, Bidirectional Ventricular Tachycardia:  

-          ventricular dysrhythmia (83%); ventricular fibrillation (23%); Torsade De pointes (9.2%). [2]

-       Bradycardia with hypotension:  (activation of the ventromedial nucleus of the hypothalamus.)

-          Death. [3]

 

Antidote and Treatment

-          Procainamide 100mg IV direct q5 minutes to a maximum of 1 g then maintenance infusion 2 - 6mg/min. (class Ia)

-          Mexiletine 200mg q8h. (class Ia)

-          Amiodarone 150mg stat. then 6支泡500 cc D5W run 34cc/ hr * 6hrs (class III)

then run 17cc/hr.* 18 hrs.

-          CPCR (23%) [3]

-          ECMO [2]

-          Hemoperfusion [2].

 

 

Disposition

Mortality rate: 15% [3]

MICU or CCU if hemodynamic changes/arrhythmia.

 

References

 

[1] Ref: http://yibian.hopto.org/esay/?eno=29

[2]. Coulson JM, Caparrotta TM, Thompson JP. The management of ventricular dysrhythmia in aconite poisoning. Clin Toxicol (Phila). 2017;55(5):313–321. doi:10.1080/15563650.2017.1291944

[3]. 2019 International Conference for Poison Control and Research Development.

 

-- March 19, 2020  

 

-- April 12, 2023   revised. by  Yu-Jang Su.