Aconitine accidental poisoning: two case reports and literature review

Chinese Herbal Medicine (CHM) is widely integrated into clinical practice across Asia and other regions for disease treatment and health maintenance. Aconitine, a potent diterpenoid alkaloid derived from plants of the Aconitum genus (e.g., Aconitum carmichaelii and Aconitum kusnezoffii), exhibits significant pharmacological activity but also considerable toxicity. While properly processed Aconitum herbs are prescribed for their analgesic and anti-rheumatic properties, inadequate detoxification during processing or improper clinical use can lead to accidental aconitine poisoning. This condition characterized by severe cardiotoxicity and neurotoxicity, which may progress to fatal outcomes. Recently, with the expanding clinical application of traditional medicines globally, the incidence of aconitine poisoning has risen, particularly in Asian populations.

We present two cases of aconitine poisoning in middle-aged patients following ingestion of herbal preparations containing aconitine. Both patients developed significant cardiac arrhythmias of varying severity. Clinical management included gastric lavage, catharsis induced by mannitol, gastric mucosal protection, intravenous fluid resuscitation, and hemoperfusion. One patient experienced cardiac arrest and subsequently died after family members elected to withdraw life-sustaining therapy. The second patient was successfully weaned from mechanical ventilation and was eventually discharged following a short-term hospitalization.

These cases emphasize the urgent need to enhance the awareness of healthcare professionals and the public regarding the risks of certain traditional Chinese medicines, especially those containing aconitine. Heightening vigilance and promoting their rational use are crucial for improving public health knowledge and preventing similar adverse events.