Aconitine, mesaconitine, and hypaconitine can induce strong contractions of the ileum through acetylcholine release from the postganglionic cholinergic nerves. Through its action on voltage-sensitive sodium channels in the axons, aconitine blocks neuromuscular transmission by decreasing the evoked quantal release of acetylcholine. It has hypotensive and bradycardic actions due to activation of the ventromedial nucleus of the hypothalamus. Aconitine has a positive inotropic effect by prolonging sodium influx during the action potential. The arrhythmogenic properties of aconitine are in part due to its cholinolytic (anticholinergic) effects mediated by the vagus nerve. The electrophysiological mechanism of arrhythmia induction is triggered activity due to delayed after-depolarization and early after-depolarization. Aconitine and mesaconitine bind with high affinity to the open state of the voltage-sensitive sodium channels at site 2, thereby causing a persistent activation of the sodium channels, which become refractory to excitation.
The cardiotoxicity and neurotoxicity of aconitine and related alkaloids are due to their actions on the voltage-sensitive sodium channels of the cell membranes of excitable tissues, including the myocardium, nerves, and muscles. Key articles with information on the use of aconite roots in traditional medicine, active (toxic) ingredients, mechanisms of toxicity, toxicokinetics of Aconitum alkaloids, and clinical features and management of aconite poisoning were reviewed. However, the use of a larger than recommended dose and inadequate processing increases the risk of poisoning.Ī Medline search (1963-February 2009) was conducted. Soaking and boiling during processing or decoction preparation will hydrolyze aconite alkaloids into less toxic and non-toxic derivatives. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal decoction made from aconite roots. The wild plant (especially the roots and root tubers) is extremely toxic. In both forensic cases, the scenery suggested a suicidal ingestion of Aconitum plant material.Aconitine and related alkaloids found in the Aconitum species are highly toxic cardiotoxins and neurotoxins. Aconitine was detected in all analyzed samples (blood, urine, gastric content and kidney) and quantified in femoral blood with 86.2 μg/L (case 1) and 2.3 μg/L (case 2), respectively.
Additionally, we found fine-vacuolar fat-negative intracytoplasmatic transformation of hepatocytes. The autopsies revealed gastric contents interspersed with plant components, blood congestion, hemorrhages in the lung tissue, lung edema and brain edema. In both cases, residual plant material was found in close proximity to the body. A 44 year and a 56 year old man were found dead in their beds. We present two unrelated cases of aconitine poisoning. However, only few cases have been described in Europe. Thus, many cases of aconitine poisoning have been reported in China and nearby countries.
The roots are often eaten or used to prepare a soup for culinary or traditional medicinal reasons. Aconitum plants have long played a major role in traditional Asian medicine and cuisine.
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