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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 30, Issue 7, September 2006,
pp.426-433
Hidden Aconite Poisoning: Identification of Yunaconitine
and Related Aconitum Alkaloids in Urine by Liquid Chromatography–Tandem
Mass Spectrometry
Chi-Kong Lai, Wing-Tat Poon, and Yan-Wo Chan
Department of Pathology, Princess Margaret Hospital, Lai Chi Kok, Hong Kong,
China
Poisoning from aconite occurs worldwide as a result of misuse
of the potent plant. Laboratory investigation into suspected intoxication cases
is challenging because the content of toxic aconitum alkaloids varies depending
on the plant source, market processing, dosing protocol, hydrolytic degradation,
and metabolic transformation. Using a triple-quadrupole tandem mass spectrometer,
a group screening method was developed based on the mass-fragmentographic scheme
of common aconitum alkaloids. The precursor-ion scans of m/z 105 and 135 permitted
selective profiling of 14-O-benzoyl-norditerpenoids and the 14-O-anisoyl-norditerpenoids,
respectively. Gradient reversed-phase liquid chromatography minimized coelution
of isobaric compounds. The screening protocol was applied to a clinical investigation
of suspected herbal poisoning. In total, 15 urine samples were thus screened
positive for aconitum alkaloid over 5 years. The diagnoses of aconite poisoning
in 11 patients were firmly established based on the known prescription history
and the positive urine finding. In four patients, without aconitum herbs being
listed in the herbal prescriptions, contamination of the herbal remedies by
aconite was suspected to be the hidden cause of their acute poisoning. Yunaconitne,
a highly toxic aconitum alkaloid, was thus identified in human urine for the
first time. The group screening method of aconitum alkaloids in urine is an
important diagnostic aid for acute poisoning by aconites of an unclear origin.
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