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Quantitative analysis of aconitine in body fluids in a case of aconitine poisoning

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Abstract

Aconitine belongs to the Aconitum alkaloids and is a natural toxic substance. Aconitine has been used as a traditional medicine in East Asian culture. Today, aconitine is still in use with or without a prescription, in the Republic of Korea. Here we present a case report of accidental death due to acute aconitine poisoning. An 81-year-old woman ingested liquid that had been heat extracted from the root of the Aconitum plant; she presented to the emergency room 1 h after ingestion. Her electrocardiogram showed irregular ventricular arrhythmias including ventricular tachycardia; she progressed to cardiac arrest. Cardiopulmonary resuscitation and anti-arrhythmic drugs were administered, but the patient did not survive. An autopsy was performed 2 days postmortem. Toxicological analysis was performed, and aconitine was detected by liquid chromatography tandem mass spectrometry. The antemortem blood concentration of aconitine was 39.1 ng/ml and the concentrations of aconitine in the postmortem cardiac blood, peripheral blood, cerebrospinal fluid (CSF), pericardial fluid, and urine were 21.1 ng/ml, 28.6 ng/ml, 6.8 ng/ml, 24.1 ng/ml, and 67.4 ng/ml, respectively. This is the first forensic case report of an aconitine poisoning death in the Republic of Korea with quantitative measurement of aconitine in the antemortem blood and various postmortem body fluids. To the best of our knowledge, this is the first report of the detection of aconitine in the CSF. These data about the distribution of aconitine in the antemortem blood and various postmortem body fluids is helpful for future aconitine poisoning death cases.

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References

  1. Niitsu H, Fujita Y, Fujita S, Kumagai R, Takamiya M, Aoki Y, et al. Distribution of Aconitum alkaloids in autopsy cases of aconite poisoning. Forensic Sci Int. 2013;227:111–7.

    Article  CAS  Google Scholar 

  2. Rentoul E, Smith H. Glaister’s medical jurisprudence and toxicology. Edinburgh, Scotland: Churchill Livingstone; 1973. p. 520–1.

    Google Scholar 

  3. Ito K, Tanaka S, Funayama M, Mizugaki M. Distribution of Aconitum alkaloids in body fluids and tissues in a suicidal case of aconite ingestion. J Anal Toxicol. 2000;24:348–53.

    Article  CAS  Google Scholar 

  4. Byard RW. A review of the potential forensic significance of traditional herbal medicines. J Forensic Sci. 2010;55:89–92.

    Article  Google Scholar 

  5. Fu M, Wu M, Wang JF, Qiao YJ, Wang Z. Disruption of the intracellular Ca2+ homeostasis in the cardiac excitation-contraction coupling is a crucial mechanism of arrhythmic toxicity in aconitine-induced cardiomyocytes. Biochem Biophy Res Commun. 2007;354:929–36.

    Article  CAS  Google Scholar 

  6. Byard RW, Musgrave I. Herbal medicines and forensic investigations. Forensic Sci Med Pathol. 2010;6:81–2.

    Article  Google Scholar 

  7. Lin CC, Chan TY, Deng JF. Clinical features and management of herb-induced aconitine poisoning. Ann Emerg Med. 2004;43:574–9.

    Article  Google Scholar 

  8. Pullela R, Young L, Gallagher B, Avis SP, Randell EW. A case of fatal aconitine poisoning by monkshood ingestion. J Forensic Sci. 2008;53:491–4.

    Article  CAS  Google Scholar 

  9. Moritz F, Compagnon P, Kaliszczak IG, Kaliszczak Y, Caliskan V, Girault C. Severe acute poisoning with homemade Aconitum napellus capsules: toxicokinetic and clinical data. Clin Toxicol (Phila). 2005;43:873–6.

    Article  Google Scholar 

  10. Dickens P, Tai YT, But PP, Tomlinson B, Ng HK, Yan KW. Fatal accidental aconitine poisoning following ingestion of Chinese herbal medicine: a report of two cases. Forensic Sci Int. 1994;67:55–8.

    Article  CAS  Google Scholar 

  11. Chan TY. Aconite poisoning following the percutaneous absorption of Aconitum alkaloids. Forensic Sci Int. 2012;226:25–7.

    Article  Google Scholar 

  12. Fujita Y, Terui K, Fujita M, Kakizaki A, Sato N, Oikawa K, et al. Five cases of aconite poisoning: toxicokinetics of aconitines. J Anal Toxicol. 2007;31:132–7.

    Article  CAS  Google Scholar 

  13. Usui K, Hayashizaki Y, Hashiyada M, Nakano A, Funayama M. Simultaneous determination of 11 Aconitum alkaloids in human serum and urine using liquid chromatography-tandem mass spectrometry. Leg Med (Tokyo). 2012;14:126–33.

    Article  CAS  Google Scholar 

  14. Liu Q, Zhuo L, Liu L, Zhu S, Sunnassee A, Liang M, et al. Seven cases of fatal aconite poisoning: forensic experience in China. Forensic Sci Int. 2011;212:e5–9.

    Article  CAS  Google Scholar 

  15. Bhargava KP, Kohli RP, Sinha JN, Tayal G. Role of catecholamines in centrogenic cardiac arrhythmia induced by aconitine. Br J Pharmacol. 1969;36:240–52.

    Article  CAS  Google Scholar 

Download references

Funding

This research was supported by the Ministry of Education and National Research Foundation of the Republic of Korea (NRF-2018R1D1A1B07049459). This study was funded by NRF-2018R1D1A1B07049459.

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Authors and Affiliations

  1. Department of Emergency Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea

    Yong Soo Cho, Byeong Jo Chun & Jeong Mi Moon

  2. Toxicology Laboratory, Chonam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea

    Ho-Woong Choi

  3. Department of Pathology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, 50612, Republic of Korea

    Joo-Young Na

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  1. Yong Soo Cho
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  2. Ho-Woong Choi
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Correspondence to Joo-Young Na.

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All authors declare that there was no conflict of interest.

This article does not contain any studies involving human participants or animals performed by the author. Moreover, this case report was based on medicolegal autopsy underwent with Court’s warrant requested by the public prosecutor.

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Cho, Y.S., Choi, HW., Chun, B.J. et al. Quantitative analysis of aconitine in body fluids in a case of aconitine poisoning. Forensic Sci Med Pathol 16, 330–334 (2020). https://doi.org/10.1007/s12024-019-00211-5

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