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Lawson C, McCabe DJ, Feldman R. A Narrative Review of Aconite Poisoning and Management. J Intensive Care Med 2024:8850666241245703. [PMID: 38613376 DOI: 10.1177/08850666241245703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Aconite poisoning refers to toxicity resulting from plants belonging to the Aconitum genus, which comprises over 350 different species of perennial flowering plants that grow in temperate mountainous areas of the northern hemisphere (North America, Europe, Asia). These plants contain a group of toxins known as aconite alkaloids, which encompass numerous closely related toxic compounds. Conventional teaching from toxicology textbooks has broadly classified these alkaloids based on their mechanism of action, often simplifying them as substances that prevent sodium channel inactivation. However, this is an oversimplified and sometimes inaccurate description, as some aconite alkaloids can act as sodium channel blockers. Aconite alkaloids have a long history of use as poisonous substances and have been historically employed for hunting, assassinations, traditional medicine, and self-inflicted harm. Toxicity can occur due to the consumption of traditional medicines derived from aconitum plants or the ingestion of aconite plants and their derivatives. The clinical manifestations of aconite poisoning may encompass gastrointestinal symptoms, sensory alterations, seizures, and life-threatening dysrhythmias that may not respond to standard treatments. Treatment is primarily supportive however evaluation and management of these patients should be personalized and carried out in collaboration with a toxicologist.
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Affiliation(s)
- Christine Lawson
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Daniel J McCabe
- Division of Medical Toxicology, Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Poison Control Center, Sioux City, IA, USA
| | - Ryan Feldman
- Department of Pharmacy, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin, School of Pharmacy, Milwaukee, WI, USA
- Department of Emergency Medicine Division of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
- Wisconsin Poison Center, Milwaukee, WI, USA
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Goumeniouk NL, Maclean DN, Howie JS, Waechter JE, Couillard P, Shaw JA, Lucyk SN. Stir Fry with a Side of Extracorporeal Membrane Oxygen: Management of Cardiogenic Shock Secondary to Unintentional Aconitine Ingestion. Wilderness Environ Med 2023; 34:567-570. [PMID: 37923684 DOI: 10.1016/j.wem.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/08/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
Plant exposures leading to systemic or topical toxicity are common presentations seen in the emergency department. While often nonfatal, certain highly toxic plants result in cardiovascular or respiratory failure requiring invasive management. We describe a 65-y-old patient who presented with a refractory ventricular dysrhythmia secondary to an unintentional ingestion of an aconitine-containing plant after incorrect identification. Despite aggressive treatment with vasopressors, intravenous fluids, antiarrhythmics, as well as electrolyte correction and multiple attempted synchronized cardioversions, the patient remained in a refractory dysrhythmia with cardiogenic shock. Venoarterial extracorporeal membrane oxygen (ECMO) therapy was initiated successfully and resulted in rapid resolution of the unstable dysrhythmia. The patient was weaned from ECMO in under 48 h and was discharged without neurological or cardiovascular sequelae. This case highlights management options available to clinicians who encounter toxicity associated with aconitine ingestion. Fatal consequences were averted, and caution is required with the use of plant-identifying applications and resources.
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Affiliation(s)
| | - Davis N Maclean
- University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Joshua S Howie
- University of Saskatchewan, Department of Psychiatry, Regina, Saskatchewan
| | - Jason E Waechter
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta
| | - Philippe Couillard
- University of Calgary, Department of Critical Care Medicine, Calgary, Alberta
| | - Jeffrey A Shaw
- University of Calgary, Department of Cardiology, Calgary, Alberta
| | - Scott N Lucyk
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta; Poison and Drug Information Service (PADIS), Alberta Health Services, Calgary, Alberta
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Arai R, Murata N, Kinoshita K, Okumura Y. Cardiotoxicity of Aconite Poisoning Evaluated by Multimodalities. Circ Cardiovasc Imaging 2022; 15:e014143. [PMID: 35770651 DOI: 10.1161/circimaging.122.014143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Riku Arai
- Division of Cardiology, Department of Medicine (R.A., N.M., Y.O.), Nihon University School of Medicine, Tokyo, Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of Medicine (R.A., N.M., Y.O.), Nihon University School of Medicine, Tokyo, Japan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine (K.K.), Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine (R.A., N.M., Y.O.), Nihon University School of Medicine, Tokyo, Japan
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Tai CJ, El-Shazly M, Tsai YH, Csupor D, Hohmann J, Wu YC, Tseng TG, Chang FR, Wang HC. Uncovering Modern Clinical Applications of Fuzi and Fuzi-Based Formulas: A Nationwide Descriptive Study With Market Basket Analysis. Front Pharmacol 2021; 12:641530. [PMID: 33986674 PMCID: PMC8110898 DOI: 10.3389/fphar.2021.641530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 01/14/2023] Open
Abstract
Background: As time evolved, traditional Chinese medicine (TCM) became integrated into the global medical system as complementary treatments. Some essential TCM herbs started to play a limited role in clinical practices because of Western medication development. For example, Fuzi (Aconiti Lateralis Radix Praeparata) is a toxic but indispensable TCM herb. Fuzi was mainly used in poor circulation and life-threatening conditions by history records. However, with various Western medication options for treating critical conditions currently, how is Fuzi used clinically and its indications in modern TCM are unclear. This study aimed to evaluate Fuzi and Fuzi-based formulas in modern clinical practices using artificial intelligence and data mining methods. Methods: This nationwide descriptive study with market basket analysis used a cohort selected from the Taiwan National Health Insurance database that contained one million national representatives between 2003 and 2010 used for our analysis. Descriptive statistics were performed to demonstrate the modern clinical indications of Fuzi. Market basket analysis was calculated by the Apriori algorithm to discover the association rules between Fuzi and other TCM herbs. Results: A total of 104,281 patients using 405,837 prescriptions of Fuzi and Fuzi-based formulas were identified. TCM doctors were found to use Fuzi in pulmonary (21.5%), gastrointestinal (17.3%), and rheumatologic (11.0%) diseases, but not commonly in cardiovascular diseases (7.4%). Long-term users of Fuzi and Fuzi-based formulas often had the following comorbidities diagnosed by Western doctors: osteoarthritis (31.0%), peptic ulcers (29.5%), hypertension (19.9%), and COPD (19.7%). Patients also used concurrent medications such as H2-receptor antagonists, nonsteroidal anti-inflammatory drugs, β-blockers, calcium channel blockers, and aspirin. Through market basket analysis, for the first time, we noticed many practical Fuzi-related herbal pairs such as Fuzi-Hsihsin (Asari Radix et Rhizoma)-Dahuang (Rhei Radix et Rhizoma) for neurologic diseases and headache. Conclusion: For the first time, big data analysis was applied to uncover the modern clinical indications of Fuzi in addition to traditional use. We provided necessary evidence on the scientific use of Fuzi in current TCM practices, and the Fuzi-related herbal pairs discovered in this study are helpful to the development of new botanical drugs.
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Affiliation(s)
- Chi-Jung Tai
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Mohamed El-Shazly
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street, Cairo, Egypt.,Department of Pharmaceutical Biology, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Yi-Hong Tsai
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dezső Csupor
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Judit Hohmann
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Yang-Chang Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Chinese Medicine Research and Development Center, China Medical University Hospital, Taichung, Taiwan
| | - Tzyy-Guey Tseng
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Rong Chang
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Chun Wang
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Bonanno G, Ippolito M, Moscarelli A, Misseri G, Caradonna R, Accurso G, Cortegiani A, Giarratano A. Accidental poisoning with Aconitum: Case report and review of the literature. Clin Case Rep 2020; 8:696-698. [PMID: 32274038 PMCID: PMC7141719 DOI: 10.1002/ccr3.2699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 11/09/2022] Open
Abstract
Aconitine intoxication by ingestion of Aconitum roots can lead to ventricular tachycardia and cardiac arrest and provides an example of the potential effect of self-medication. Educational campaigns should be implemented to contain acute intoxications caused by herbal-derived products.
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Affiliation(s)
- Giuseppe Bonanno
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Alessandra Moscarelli
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Giovanni Misseri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Rosaria Caradonna
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Giuseppe Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)Section of Anesthesia, Analgesia, Intensive Care and EmergencyPoliclinico Paolo GiacconeUniversity of PalermoPalermoItaly
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Qi X, Wang L, Wang H, Yang L, Li X, Wang L. Aconitine inhibits the proliferation of hepatocellular carcinoma by inducing apoptosis. Int J Clin Exp Pathol 2018; 11:5278-5289. [PMID: 31949608 PMCID: PMC6963040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 06/10/2023]
Abstract
Hepatocellular carcinoma (HCC) is the primary liver cancer that occurs with a high incidence in Asia. Owing to the poor prognosis of the disease, the mortality rate remains high, making HCC the third most common cause of cancer-related mortality worldwide. Studies on current therapies have generated little empirical evidence in improving the survival rate of patients with advanced HCC. Certain agents have exhibited promising results in molecular targeted therapy, but they remain in clinical trials. Aconitine, a main bioactive constituent of a traditional Chinese herb, Wutou, and belonging to the Aconitum genus, has been demonstrated to inhibit the growth of certain tumors, including HCC, but the underlying molecular mechanism by which aconitine inhibits tumor growth is largely unknown. In the present study, aconitine was applied to two types of hepatic carcinoma cells and normal hepatic cells at various concentrations, and it was found to specifically inhibit the proliferation of cancer cells in a dose-dependent manner. Further study found that aconitine activated the production of reactive oxygen species, leading to an increased release of cytochrome c from mitochondria and the activation of apoptosis. This is demonstrated by the increased cleavage of caspases 3 and 7, as well as an increased B-cell lymphoma 2 (Bcl-2)-associated X protein level and a decreased Bcl-2 level in cancer cells. An in vivo study also found that aconitine was able to inhibit the growth of tumors in mice. The results of the present study suggest that aconitine has the potential to be developed into an effective anti-HCC agent.
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Affiliation(s)
- Xiuzhong Qi
- Department of Traditional Chinese Medicine, The Qingdao First Sanitarium of NavyQingdao, PR China
| | - Lin Wang
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical UniversityShanghai, PR China
| | - Huan Wang
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical UniversityShanghai, PR China
| | - Ling Yang
- Vocational Education College, Dezhou UniversityDezhou, PR China
| | - Xia Li
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical UniversityShanghai, PR China
| | - Lina Wang
- Department of Traditional Chinese Medicine, Changhai Hospital, Naval Medical UniversityShanghai, PR China
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Weijters BJ, Verbunt RJAM, Hoogsteen J, Visser RF. Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus. Neth Heart J 2008; 16:96-9. [PMID: 18345331 PMCID: PMC2266867 DOI: 10.1007/bf03086125] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Intoxication with Aconitum napellus is rare in our regions. Aconite alkaloids can cause ventricular arrhythmia by a prolonged activation of sodium channels. Because the margin of safety is low between the analgesic and toxic dose, intoxication is not rare when Aconite is used in herbal medicine. We present a case in which a 39-year-old male was accidentally intoxicated with Aconite. Even though no antidote or adequate therapy is available he was successfully resuscitated. (Neth Heart J 2008;16:96-9.).
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Affiliation(s)
- B J Weijters
- Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands
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