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Charcoal hemoperfusion for aconite poisoning: Insights from a CKD case and complementary simulation experiments
Yoshiaki Oshima1,2, Akihiro Otsuki1, Yukari Minami1
1Division of Anesthesiology and Critical Care Medicine, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine.
The Journal of Toxicological Sciences
|August 3, 2026
Summary
Charcoal hemoperfusion (CHP) effectively removes toxic aconite alkaloids (DDAs) from the blood, even in patients with severe kidney disease. This study shows CHP
Area of Science:
- Toxicology
- Nephrology
- Pharmacokinetics
Background:
- Aconite poisoning involves highly toxic diester-diterpene alkaloids (DDAs).
- Charcoal hemoperfusion (CHP) shows potential for treating aconite poisoning, particularly in East Asian cases.
Purpose of the Study:
- To evaluate the efficacy of charcoal hemoperfusion (CHP) in eliminating toxic aconite alkaloids (DDAs).
- To assess CHP's effectiveness in a patient with severe renal impairment and aconite poisoning.
Main Methods:
- Two simulations: activated charcoal adsorption capacity and perfusate concentration.
- One clinical case: a 61-year-old female with stage V CKD and aconite poisoning treated with CHP.
Main Results:
- Activated charcoal demonstrated a saturated adsorption capacity of 110 mg aconitine/g.
- CHP removed most aconitine in a single pass during simulations.
- In the clinical case, plasma DDA concentrations decreased rapidly with CHP, showing a clearance of ~70 mL/min.
Conclusions:
- CHP can significantly contribute to the elimination of diester-diterpene alkaloids (DDAs) in patients with severe renal impairment.
- The long elimination half-life of DDAs in the patient suggests impaired renal excretion.
- Further research is needed to determine the broader clinical relevance of CHP for aconite poisoning.
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