Clinical features and management of aconite poisoning induced-arrythmia in 30 cases

Aconite is a well-known toxic plant that contains highly toxic aconitines that cause aconite poisoning. We report an investigation of the clinical features and management of aconite poisoning induced-arrhythmia in cases of aconite poisoning. The subjects were 30 patients with aconite poisoning who were admitted to the Critical Care and Emergency Center at Iwate Medical University between 1984 and 2011. Medical charts were reviewed to obtain information on the background characteristics of the patients, including the cause, occurrence time, symptoms and treatment of intoxication; the ingested plant parts; and the outcome. The subjects comprised 22 males and 8 females, and ranged in age from 5 to 78 years old (mean age, 48.3 years old). The causes of intoxication were ingestion of aconite for suicide and attempted suicide in 15 cases, mistaken ingestion of the plant instead of edible wild plants in 14 cases, and ingestion of the plant as a folk remedy in 1 case. The suicide attempts and suicide cases tended to involve ingestion of aconite roots and occurred in seasons throughout the year. The mistaken ingestion cases tended to involve ingestion of aconite leaves and mainly occurred between April and June, in the season for collecting edible wild plants. The symptoms of intoxication were circumoral paresthesia (23 cases), numbness of the extremities (23 cases), paralysis (5 cases), weakness (11 cases), dizziness (9 cases), consciousness disorder (13 cases), nausea/vomiting (24 cases), abdominal pain (4 cases), palpitation (19 cases), chest pain/chest discomfort (17 cases), hypotension (18 cases), and arrhythmias (26 cases). The arrhythmias varied in type, but were mostly premature ventricular contractions (17/26 cases, 65.4%). Of the 26 cases that developed arrhythmia, 7 had fatal arrhythmia such as ventricular fibrillation (VF). Antiarrhythmic agents such as lidocaine were administered in cases with tachyarrhythmia. These agents were ineffective for patients with VF, but effective for other patients. Percutaneous cardiopulmonary support (PCPS) was effective in VF patients with unstable hemodynamics due to arrhythmia refractory to treatment with antiarrhythmic agents and defibrillation. Overall, antiarrhythmic therapy seems to have little effect on aconite poisoning-induced VF, and an episode of severe arrhythmia influences the outcome. Therefore, a severe case with VF refractory to antiarrhythmic therapy requires aggressive treatment with PCPS for stabilization of hemodynamics. These results provide useful information for future treatment of aconite poisoning.