Abstract
A 69-year-old woman with previous history of depression ingested ornamental aconite root with the intent to commit suicide. Upon experiencing chest pains, she called an ambulance and arrived at our hospital 30 minutes after ingesting the aconite root, and still in possession of it. On admission, frequent ventricular extrasystole and hypotension were confirmed, and artificial ventilation, gastric irrigation, activated charcoal administration and lidocaine hydrochloride administration were performed. Although the patient's hemodynamics transiently improved, various forms of arrhythmia, such as atrioventricular dissociation and bundle branch block, occurred. As a result, direct hemoperfusion (DHP) was performed twice to eliminate the aconitine alkaloids (AA) from the body. Soon after DHP, arrhythmias disappeared and hemodynamics improved. Blood and urinary AA levels were measured a total of four times (on admission, after each DHP, and the day after admission), aconitine (AC), hypaconitine (HC) and mesaconitine (MC) levels were quantified. The results showed that AA were not detected in the blood at any point, and as a result, the ability of DHP to eliminate AA could not be verified. This case was relatively rare in that the patient ingested ornamental aconite rather than wild aconite. It has been shown that the AA concentration of aconite varies depending on variety, part of the plant, growing condition and time of harvest. The composition of AA of the ingested aconite root was analyzed, and the level of MC was about nine times greater than that of AC, with urinary MC level being the highest. Therefore, while AC poisoning is usually suspected in aconite poisoning, MC was the major poisoning agent in the present patient. The above findings suggest that it is necessary to test and quantify not only AC, but also MC in cases of both wild and ornamental aconite poisoning.
