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A fatal case of aconite poisoning: accidental intake of a monkshood extract

Abstract

Purpose

Monkshood is a wild growing plant which contains the very toxic alkaloid aconitine, and is often used in traditional Chinese medicine. In this case report, we describe a fatal accident after the unintentional consumption of an aconite extract.

Method

By applying high-performance liquid chromatography–tandem mass spectrometry, the distribution of the alkaloid aconitine in body fluids and organ tissues has been determined, as well as the concentration of the extract taken from the confiscated bottle.

Results

The concentration of aconitine in peripheral blood of the deceased was 19 ng/mL; the highest concentration in organ tissue was found in the liver specimen, which revealed a content of 205 ng/g, followed by the kidneys, lungs, muscle and the brain. Moreover, aconitine contents of the blossoms, roots and leaves of a wild growing monkshood were determined. The plant extract itself showed a high concentration (628 mg/L) of the alkaloid.

Conclusion

The present case report emphasizes the danger of aconite extracts and presents results of the distribution of the alkaloid in the human body.

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Fig. 1

References

  1. 1.

    Bisset NG (1981) Arrow poisons in China. part II. Aconitum—botany, chemistry, and pharmacology. J Ethnopharmacol 4:247–336

    CAS  Article  Google Scholar 

  2. 2.

    Chan TY (1994) Aconitine poisoning: A global perspective. Vet Hum Toxicol 36:326–328

    CAS  PubMed  Google Scholar 

  3. 3.

    Chan TY, Tomlinson B, Tse LK, Chan JC, Chan WW, Critchley JA (1994) Aconitine poisoning due to Chinese herbal medicines: a review. Vet Hum Toxicol 36:452–455

    CAS  PubMed  Google Scholar 

  4. 4.

    Miyaguchi H, Sekine H (2009) Homicide involving Aconitum tuberous root: LC-MS-MS analysis of Aconitum alkaloids and their hydrolysates in formalin-fixed tissues. Forensic Toxicol 28:47–51

    Article  Google Scholar 

  5. 5.

    Pullela R, Young L, Gallagher B, Avis SP, Randell EW (2008) A case of fatal aconitine poisoning by Monkshood ingestion. J Forensic Sci 53:491–494

    CAS  Article  Google Scholar 

  6. 6.

    Li H, Liu L, Zhu S, Liu Q (2016) Case reports of aconite poisoning in mainland China from 2004 to 2015: a retrospective analysis. J Forensic Leg Med 42:68–73

    CAS  Article  Google Scholar 

  7. 7.

    Liu Q, Zhuo L, Liu L, Zhu S, Sunnassee A, Liang M, Zhou L, Liu Y (2011) Seven cases of fatal aconite poisoning: Forensic experience in China. Forensic Sci Int 212:e5–9

    CAS  Article  Google Scholar 

  8. 8.

    Elliott SP (2002) A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid. Sci Justice 42:111–115

    CAS  Article  Google Scholar 

  9. 9.

    Eberl M, Seidel M (2018) Accidental poisoning with aconite napel (monkshood): Simultaneous treatment of two patients. Med Klin Intensivmed Notfmed 113:574–576

    CAS  Article  Google Scholar 

  10. 10.

    Sheth S, Tan EC, Tan HH, Tay L (2015) Herb-induced cardiotoxicity from accidental aconitine overdose. Singapore Med J 56:e116–119

    Article  Google Scholar 

  11. 11.

    Chan TY (2009) Aconite poisoning. Clin Toxicol 47:279–285

    CAS  Article  Google Scholar 

  12. 12.

    Ng SW, Ching CK, Chan AY, Mak TW (2013) Simultaneous detection of 22 toxic plant alkaloids (aconitum alkaloids, solanaceous tropane alkaloids, sophora alkaloids, strychnos alkaloids and colchicine) in human urine and herbal samples using liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 942–943:63–69

    Article  Google Scholar 

  13. 13.

    Ludewig R, Lohs K (1988) Akute Vergiftungen Ratgeber für toxikologische Notfälle. Gustav Fischer Verlag, Jena

    Google Scholar 

  14. 14.

    Niitsu H, Fujita Y, Fujita S, Kumagai R, Takamiya M, Aoki Y, Dewa K (2013) Distribution of Aconitum alkaloids in autopsy cases of aconite poisoning. Forensic Sci Int 227:111–117

    CAS  Article  Google Scholar 

  15. 15.

    Ito K, Tanaka S, Funayama M, Mizugaki M (2000) Distribution of aconitum alkaloids in body fluids and tissues in a suicidal case of aconite ingestion. J Anal Toxicol 24:348–353

    CAS  Article  Google Scholar 

  16. 16.

    Ito K, Ohyama Y, Hishinuma T, Mizugaki M (1996) Determination of Aconitum alkaloids in the tubers of Aconitum japonicum using gas chromatography/selected ion monitoring. Planta Med 62(1):57–59

    CAS  Article  Google Scholar 

  17. 17.

    Chan TY (2012) Aconitum alkaloid content and the high toxicity of aconite tincture. Forensic Sci Int 222:1–3

    CAS  Article  Google Scholar 

  18. 18.

    Chan TY, Critchley JA (1996) Usage and adverse effects of Chinese herbal medicines. Hum Exp Toxicol 15:5–12

    CAS  Article  Google Scholar 

Download references

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Correspondence to Marc Bartel.

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The authors declare that there is no conflict of interest regarding the publication of this article.

Ethical approval

We confirm that this case selected for this work underwent medicolegal autopsies directed by the public prosecutor. All forensic and toxicological tests were performed as part of investigations. The public prosecutor gave permission for this case to be published.

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Hofmann, V., Landmann, A., Schmitt, G. et al. A fatal case of aconite poisoning: accidental intake of a monkshood extract. Forensic Toxicol 38, 511–516 (2020). https://doi.org/10.1007/s11419-020-00526-x

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Keywords

  • Aconitine
  • Monkshood
  • HPLC–MS/MS
  • Distribution
  • Intoxication