Mass aconite poisoning from a mislabelled spice product

Aconitine is a potentially lethal alkaloid found in more than 200 plant species belonging to the genus Aconitum (aconite). Most cases of poisoning involve the improper processing of traditional Chinese medicine. We report a mass poisoning event caused by consumption of unprocessed aconite root powders mislabeled as sand ginger.

We conducted a retrospective case series of patients who presented to two hospitals in the Greater Toronto area with aconite poisoning from a chicken dish eaten at a local restaurant. Demographic, management, and outcome data were collected by review of the electronic medical record.

Over an 8 h period, 11 patients presented to hospital with features of aconite poisoning. Symptoms began shortly after ingestion and included perioral paraesthesia (91%) and nausea, vomiting and abdominal pain (64%). In the hospital, the spectrum of illness varied from paraesthesia requiring no intervention (9%) to refractory ventricular dysrhythmias (73%) managed with infusions of sodium bicarbonate, amiodarone, and vasopressors. Two patients received mechanical ventilation for 48 h. No patients died. A public health investigation identified a mislabelled sand ginger spice product imported from China as the source of unprocessed aconite (aconitine 0.55%).

With the increasing availability of internationally sourced spice products, such events are likely to recur.

This series demonstrates the potential for mass aconite poisoning through contaminated food and highlights the critical role of poison centers and public health systems in responding to such events.