II. Definitions
- Aconite
- Toxic diterpenoid alkaloid root extract from plants in the Aconitum genus (esp. Aconitum napellus)
- Aconite contains aconitine, mesaconitine and hypaconitine
- Aconitum
- Aconitum is a plant genus within the family ranunculaceae
- Plants in this genus contain varius diterpenoid alkaloids including aconitans
- Diterpenoid Alkaloid
- Group of more than 1500 identified complex substances synthesized by plants
- Associated with both medicinal and toxic properties
III. Background
- Aconite is alkaloid group extracted from Aconitum napellus root (contains aconitine, mesaconitine and hypaconitine)
- Aconitum was the first Diterpenoid Alkaloid group to be identified (in early 1800s by Geiger)
- Ancient tribes applied Aconitum to arrow tips for hunting and war
IV. Pathophysiology
- Accidental or intentional ingestion
- Wolfsbane Plant
- Monkshood Plant
- Aconite root extract (herbal medications)
- Aconitite binds voltage-sensitive Sodium channels in their open state
- Results in neurovascular and cardiovascular toxicity
V. Pharmacokinetics
- Rapid absorption after ingestion
- Half-Life: 24 hours
- Lethal dose: 2 g Aconite (root extract)
VI. Findings
- Cardiovascular
- Respiratory
- Respiratory Muscle Paralysis with apnea
- Gastrointestinal
- Neurologic
- Paresthesias
- Numbness (perioral, extremity)
- Motor weakness
VII. Labs
- See Unknown Ingestion (includes full spectrum toxicology testing)
- Bedside Glucose
- Basic metabolic panel with Calcium
- Serum Magnesium
- Aconitine Levels (urine and blood)
VIII. Diagnostics
IX. Management
-
Gastric Decontamination if within one hour of ingestion and can control airway
- Oral Activated Charcoal
- Cardiovascular Management
- Symptomatic Bradycardia
- Hypotension
- Intravenous Fluids
- Vasopressors (e.g. Norepinephrine) for refractory Hypotension
- ECMO for Vasopressor refractory Hypotension
- Ventricular Tachycardia
- Amiodarone or Flecainide are preferred over Lidocaine
- May be refractory to Electrical Cardioversion
- Replace Electrolytes
- Disposition
- Cardiovascular effects require intensive monitoring
- Other symptoms (e.g. gastrointestinal) should be medically monitored until resolution
- Asymptomatic patients may be discharged to home observation
X. Resources
- Aconitum napellus(Monkshood): A Purple Poison (Poison Control)
- Aconitum (Wikipedia)
XI. References
- Tomaszewski (2022) Crit Dec Emerg Med 36(4): 36
- Chan (2009) Clin Toxicol 47(4):279-85 +PMID: 19514874 [PubMed]
- Thawabteh (2021) Molecules 26(13):4103 +PMID: 34279443 [PubMed]
- Wood (2020) J Crit Care Med 6(2):124-129 +PMID: 32426520 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
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) |
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 |
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 |
Ontology: Wolfsbane (organism) (C0446219)
| Concepts | Plant (T002) |
| SnomedCT | 264346009 |
| English | Wolfsbane (organism), Wolfsbane |
| Spanish | luparia, matalobos (organismo), matalobos, uva lupina |
