Aconite Poisoning

Aka: Aconite Poisoning, Aconite Toxicity, Aconite, Aconitum Poisoning, Monkshood Poisoning, Wolfsbane Poisoning, Wolfsbane, Aconitum, Aconitum napellus, Monkshood

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II. Definitions

  1. Aconite
    1. Toxic diterpenoid alkaloid root extract from plants in the Aconitum genus (esp. Aconitum napellus)
    2. Aconite contains aconitine, mesaconitine and hypaconitine
  2. Aconitum
    1. Aconitum is a plant genus within the family ranunculaceae
    2. Plants in this genus contain varius diterpenoid alkaloids including aconitans
  3. Diterpenoid Alkaloid
    1. Group of more than 1500 identified complex substances synthesized by plants
    2. Associated with both medicinal and toxic properties

III. Background

  1. Aconite is alkaloid group extracted from Aconitum napellus root (contains aconitine, mesaconitine and hypaconitine)
  2. Aconitum was the first Diterpenoid Alkaloid group to be identified (in early 1800s by Geiger)
  3. Ancient tribes applied Aconitum to arrow tips for hunting and war

IV. Pathophysiology

  1. Accidental or intentional ingestion
    1. Wolfsbane Plant
    2. Monkshood Plant
    3. Aconite root extract (herbal medications)
  2. Aconitite binds voltage-sensitive Sodium channels in their open state
    1. Results in neurovascular and cardiovascular toxicity

V. Pharmacokinetics

  1. Rapid absorption after ingestion
  2. Half-Life: 24 hours
  3. Lethal dose: 2 g Aconite (root extract)

VI. Findings

  1. Cardiovascular
    1. Hypotension
    2. Dysrhythmia
      1. Atrial Fibrillation
      2. Torsades de Pointes
      3. Ventricular Tachycardia
  2. Respiratory
    1. Respiratory Muscle Paralysis with apnea
  3. Gastrointestinal
    1. Nausea or Vomiting
    2. Diarrhea
    3. Abdominal Pain
    4. Hypersalivation
  4. Neurologic
    1. Paresthesias
    2. Numbness (perioral, extremity)
    3. Motor weakness

VII. Labs

  1. See Unknown Ingestion (includes full spectrum toxicology testing)
  2. Bedside Glucose
  3. Basic metabolic panel with Calcium
  4. Serum Magnesium
  5. Aconitine Levels (urine and blood)

VIII. Diagnostics

  1. Electrocardiogram

IX. Management

  1. Gastric Decontamination if within one hour of ingestion and can control airway
    1. Oral Activated Charcoal
  2. Cardiovascular Management
    1. Symptomatic Bradycardia
      1. Atropine
    2. Hypotension
      1. Intravenous Fluids
      2. Vasopressors (e.g. Norepinephrine) for refractory Hypotension
      3. ECMO for Vasopressor refractory Hypotension
    3. Ventricular Tachycardia
      1. Amiodarone or Flecainide are preferred over Lidocaine
      2. May be refractory to Electrical Cardioversion
  3. Replace Electrolytes
    1. Potassium Replacement in Hypokalemia
    2. Magnesium Replacement in Hypomagnesemia
  4. Disposition
    1. Cardiovascular effects require intensive monitoring
    2. Other symptoms (e.g. gastrointestinal) should be medically monitored until resolution
    3. Asymptomatic patients may be discharged to home observation

X. Resources

  1. Aconitum napellus(Monkshood): A Purple Poison (Poison Control)
    1. https://www.poison.org/articles/why-is-monkshood-considered-a-poison--174
  2. Aconitum (Wikipedia)
    1. https://en.wikipedia.org/wiki/Aconitum

XI. References

  1. Tomaszewski (2022) Crit Dec Emerg Med 36(4): 36
  2. Chan (2009) Clin Toxicol 47(4):279-85 +PMID: 19514874 [PubMed]
  3. Thawabteh (2021) Molecules 26(13):4103 +PMID: 34279443 [PubMed]
  4. Wood (2020) J Crit Care Med 6(2):124-129 +PMID: 32426520 [PubMed]

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Related Studies

Ontology: Aconite (C0001157)

Definition (MSH) Dried root of Aconitum napellus.
Concepts Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Hazardous or Poisonous Substance (T131) , Organic Chemical (T109)
MSH D031841
English Aconite, aconite, Aconites, Radix Aconitus, Aconitus, Radix, Aconiti, Radix, Aconite Root, Monkshood Root, Friar's Cap Root, Venus' Chariot Root, Aconitum napellus Root, Wolfsbane Root, Aconitum, Radix, Radix Aconitum, Aconiti Radix, ACONITUM NAPELLUS ROOT, Radix Aconiti
Czech oměj
French Aconit, Radix Aconiti
German Aconit
Norwegian Hjelm
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Aconitum species poisoning (C0275156)

Concepts Injury or Poisoning (T037)
SnomedCT 59538008
Spanish intoxicación por especie de Aconitum (trastorno), intoxicación por especie de Aconitum, intoxicación por especies de Aconitum (trastorno), intoxicación por especies de Aconitum, intoxicación por anapelo, intoxicación por napelo
English Aconite poisoning, Aconitum species poisoning, Monkshood poisoning, Aconitum species poisoning (disorder)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Aconitum (C0330240)

Definition (MSH) A plant genus of the family RANUNCULACEAE. Members contain a number of diterpenoid alkaloids including: aconitans, hypaconitine, ACONITINE, jesaconitine, ignavine, napelline, and mesaconitine. The common name of Wolfbane is similar to the common name for ARNICA.
Concepts Plant (T002)
MSH D031841
SnomedCT 56988008
English Aconitum, Aconitums, aconitum, aconite, Aconite, Monkshood, Aconitum (organism), Aconitum, NOS
Swedish Aconitum
Czech Aconitum
Finnish Aconitum
Russian BORETS, AKONIT, MONASHII KLOBUK, АКОНИТ, БОРЕЦ, МОНАШИЙ КЛОБУК
Japanese トリカブト, アコニット, トリカブト属
Polish Tojad mocny
Norwegian Aconitum, Hjelmslekta
Spanish Acónito, Aconitum (organismo), anapelo, napelo, Aconitum
Portuguese Mata-Lobos, Acônito, Aconitum
French Aconitum
German Aconitum
Italian Aconitum
Dutch Aconitum
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Aconitum napellus (plant) (C0330244)

Concepts Plant (T002)
MSH D031841
SnomedCT 18784007
English Monkshood, Aconitum napellus (plant), napellus, Aconitum, Monkshoods, Aconitum napellus (organism), Aconitum napellus
Czech oměj šalamounek, Aconitum napellus
German Eisenhut
French Aconit casque-de-Jupiter, Aconitum napellus, Aconit napel, Casque-de-Jupiter, Capuchon-de-moine, Aconit tue-loup, Char-de-Vénus
Italian Aconito napello
Norwegian Venusvogn, Aconitum napellus, Storhjelm
Spanish Aconitum napellus (organismo), Aconitum napellus, Monacato
Dutch Monnikskap
Portuguese Mata-Leopardos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Wolfsbane (organism) (C0446219)

Concepts Plant (T002)
SnomedCT 264346009
English Wolfsbane (organism), Wolfsbane
Spanish luparia, matalobos (organismo), matalobos, uva lupina
Derived from the NIH UMLS (Unified Medical Language System)

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