Published: Journal of Analytical Toxicology, ISSN 0146-4760, Volume 31, Number 3, April 2007, pp.132-137

Five Cases of Aconite Poisoning: Toxicokinetics of Aconitines
Yuji Fujita[1,2], Katsutoshi Terui[3], Megumi Fujita[1,2], Atsushi Kakizaki[2], Norio Sato[3], Kohei Oikawa[3], Hidehiko Aoki[3], Katsuo Takahashi[2], and Shigeatsu Endo[3]
[1]Poisoning and Drug Laboratory Division, Critical Care and Emergency Center, Iwate Medical University Hospital, 3-16-1 Honchoudori, Morioka, Iwate 020-0015, Japan;
[2]Department of Pharmacy, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan; and
[3]Department of Emergency Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan

Aconite poisoning was examined in five patients (four males and one female) aged 49 to 78 years old. The electrocardiogram findings were as follows: ventricular tachycardia and ventricular fibrillation in case 1, premature ventricular contraction and accelerated idioventricular rhythm in case 2, AIVR in case 3, and nonsustained ventricular tachycardia in cases 4 and 5. The patient in case 1 was given percutaneous cardiopulmonary support because of unstable hemodynamics, whereas the other patients were treated with fluid replacement and antiarrhythmic agents. The main aconitine alkaloid in each patient had a half-life that ranged from 5.8 to 15.4 h over the five cases, and other detected alkaloids had half-lives similar to the half-life of the main alkaloid in each case. The half-life of the main alkaloid in case 1 was about twice as long as the half-lives in the other cases, and high values for the area under the blood concentration-time curve and the mean residence time were only observed in case 1. These results suggest that alkaloid toxicokinetics parameters may reflect the severity of toxic symptoms in aconite poisoning.

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