So Young Jeon1, Wonjoon Jeong1, Jung Soo Park2, Yeonho You1, Hong Joon Ahn1, Suncheun Kim3, Dongwoo Kim3, Dongeun Park3, Hyejin Chang3, Seung Whan Kim4. 1. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea. 2. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea; Department of Emergency Medicine, College of medicine, Chungnam National University, Daejeon, South Korea. 3. Forensic Toxicology Division, National Forensic Service, Daejeon, South Korea. 4. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea; Department of Emergency Medicine, College of medicine, Chungnam National University, Daejeon, South Korea. Electronic address: emdfire@hanmail.net.
Abstract
BACKGROUND: Aconitine is well-known for its potential analgesic, anti-inflammatory, and circulation promoting effects and has been widely used as a folk medicine in South Korea. Owing to its extremely toxic nature and relatively low safety margin, intoxication is sometimes fatal. The toxic compound mainly affects the central nervous system, heart, and muscle, resulting in cardiovascular complications. PURPOSE: To determine the exact relationship between blood concentration of aconitine and clinical manifestation. BASIC PROCEDURES: The National Forensic Service (NFS) was commissioned to assist in a quantitative analysis of highly toxic aconitine and corresponding blood concentrations by analyzing the body fluids of three patients who were suspected of aconitine poisoning. MAIN FINDINGS: Aconitine blood values tested by the NFS showed that patients with a blood concentration below a certain level developed symptoms slowly and showed a high severity of clinical manifestation. There was no correlation between blood concentration and symptoms or ECG results. CONCLUSIONS: In case of suspected aconitine poisoning, an emergency care department should be visited, even with symptomatic improvement, and the patient should be monitored for at least 24 h, depending on the level of recovery and changes in ECG results.
BACKGROUND:Aconitine is well-known for its potential analgesic, anti-inflammatory, and circulation promoting effects and has been widely used as a folk medicine in South Korea. Owing to its extremely toxic nature and relatively low safety margin, intoxication is sometimes fatal. The toxic compound mainly affects the central nervous system, heart, and muscle, resulting in cardiovascular complications. PURPOSE: To determine the exact relationship between blood concentration of aconitine and clinical manifestation. BASIC PROCEDURES: The National Forensic Service (NFS) was commissioned to assist in a quantitative analysis of highly toxic aconitine and corresponding blood concentrations by analyzing the body fluids of three patients who were suspected of aconitinepoisoning. MAIN FINDINGS:Aconitine blood values tested by the NFS showed that patients with a blood concentration below a certain level developed symptoms slowly and showed a high severity of clinical manifestation. There was no correlation between blood concentration and symptoms or ECG results. CONCLUSIONS: In case of suspected aconitinepoisoning, an emergency care department should be visited, even with symptomatic improvement, and the patient should be monitored for at least 24 h, depending on the level of recovery and changes in ECG results.