Aconitine poisoning as a rare cause of pulseless diffuse ventricular arrhythmia: a case report

A middle-aged woman presented with nausea and vomiting after consumption of dinner. Her son experienced similar symptoms after sharing the meal. The patient had a history of syncope and had been treated with a dual-chamber pacemaker years prior to the incident. While being treated by emergency medical services (EMS), the patient developed pulseless wide complex tachycardia. EMS performed cardiopulmonary resuscitation (CPR) and several defibrillation attempts. After being referred to our intensive care unit (ICU), initial workup revealed no evidence of structural heart disease, coronary artery disease, or electrolyte imbalances. The patient was treated with multiple defibrillations, including double-sequence defibrillation, antiarrhythmic drugs, and continuous Veno-Venous hemodialysis in the following hours. Due to similar symptoms in both the patient and her son following food intake, multiple body fluids were sampled for toxicological screening. The results revealed evidence of acute aconitine poisoning. Despite undergoing CPR for approximately 45 min, the patient stabilized over the following days and ultimately showed no significant neurological deficiencies. The legal review of the case concluded that the poisoning had occurred in a homicidal context.