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A case of aconitine poisoning with analysis of aconitine alkaloids by GC/SIM.

Described here is a fatal case of accidental aconitine poisoning following the ingestion of aconite, Torikabuto, mistaken for an edible grass, Momijigasa. A 61-year-old man developed symptoms of nausea, diarrhea, and discomfort of the body about 2 h after the ingestion and was taken to an emergency room. Resuscitation and antiarrhythmic drugs were ineffective, and ventricular tachycardia and fibrillation developed and lasted for 6 h. He was transferred to a coronary care unit and complete sinus rhythm was obtained on an electrocardiogram 30 h after his admission. The patient fell into a coma and died of brain edema diagnosed by CT on the 6th day. Consent for autopsy was denied by the family but was given for gas chromatography/selected ion monitoring (GC/SIM) to analyze the toxicity of aconitine alkaloids in the blood and the urine. Only a faint amount of jesaconitine was detected, while aconitine, mesaconitine and hypaconitine were not detectable in the blood 24 h after ingestion. On the other hand, aconitine and its related alkaloids such as mesaconitine, jesaconitine, and hypaconitine were clearly detected in the urine.

Aconitine

The positive inotropic effect of aconitine.

1. The inotropic and electrophysiological effects of aconitine were measured in the isolated, isometrically contracting guinea-pig papillary muscle during the prearrhythmic phase of alkaloid action. 2. In muscles stimulated continually at 1 Hz, 1 mumol/l aconitine produced a positive inotropic effect that reached 38 +/- (SEM) 9% immediately before the onset of arrhythmia (n = 3). 3. If aconitine (0.5 mumol/l) was applied to non-stimulated (resting) muscles for 30 min and 1-Hz stimulation resumed thereafter, the arrhythmia occurred after 724 +/- 101 beats. Prolongation of the rest exposure to 2 h did not significantly diminish the number of prearrhythmic beats. Thus, the onset of aconitine action is critically determined by muscle activity (rather than by time), and a 30-min aconitine application to the resting muscle suffices for complete equilibration of the tissue. 4. Using the preequilibration-at-rest procedure, the positive inotropic effect of aconitine (0.25 - 4 mumol) was found (a) to be absent in the rested-state contraction, (b) to grow with both number of subsequent beats and alkaloid concentration, and (c) to reach a similar prearrhythmic maximum at all concentrations. This maximum amounted to about 1/4 of the maximum positive inotropic effect of dihydroouabain. It was not influenced by reserpine pretreatment of the guinea pig. 5. Aconitine (1 mumol/l) delayed the repolarization phase of the action potential by establishing a secondary plateau at approximately -60 mV. This effect paralleled the positive inotropic effect and, like the positive inotropic effect, was abolished by 10 mumol/l tetrodotoxin (TTX). In partially depolarized muscles ([K]0 = 24 mmol/l) aconitine (8 mumol/l) produced a TTX-sensitive increase in amplitude and rate of rise of the rested-state contraction; this indicates a voltage-dependent effect on some resting Na channels. 6. While delaying the late repolarization phase, aconitine markedly shortened the early repolarization at levels positive to -40 mV, reduced the overshoot and decreased the maximum rat of depolarization of the action potential. Slow action potentials ([K]0 = 24 mmol/l; 10 mumol/l TTX) were insensitive to aconitine. 7. We conclude that the well known property of aconitine to prolong the Na influx during the action potential leads to a positive inotropic effect, thus confirming the importance of Na influx for the regulation of myocardial contractility. The exact mechanism of an additional effect by which aconitine reduces the overshoot and shortens the plateau phase of the action potential awaits further study.

Aconitine

R 56 865, a Na+/Ca(2+)-overload inhibitor, protects against aconitine-induced cardiac arrhythmias in vivo.

Disturbances in cellular Na+/Ca2+ homeostasis may play a central role in the pathogenesis of ventricular arrhythmias and cell damage induced by the alkaloids veratridine and aconitine in vitro. To test this hypothesis in vivo, the effects on aconitine-induced arrhythmias of intravenous (i.v.) pretreatment with R 56 865 (a Na(+)- and Ca(2+)-overload inhibitor) were compared with those of lidocaine, verapamil, and tetrodotoxin (TTX) in anesthetized rats (n = 10 for each compound). The i.v. bolus injection of aconitine (6.2, 12.5, or 25 micrograms/kg) induced ventricular premature beats (VPBs), ventricular tachycardia (VT), ventricular fibrillation (VF), and mortality in a dose-dependent manner. Because aconitine at a dose of 12.5 micrograms/kg i.v. resulted in a high incidence of ventricular arrhythmias as well as mortality, this dose was used in further tests. Pretreatment of rats with R 56 865 (1.25 mg/kg) significantly reduced the incidences of aconitine-induced VT and VF, as well as mortality, relative to the saline control group. Pretreatment with verapamil (0.32 mg/kg), was ineffective against aconitine-induced ventricular arrhythmias and mortality. Pretreatment with lidocaine (10 mg/kg) significantly reduced the incidence of VT and caused low but not significant reductions in the incidences of VF and mortality induced by aconitine. Pretreatment with a selective sodium channel blocker TTX (4 micrograms/kg) also significantly reduced the incidences of VT, VF, and mortality elicited by aconitine. These results suggest that intracellular Na+ loading plays an important role in aconitine-induced ventricular arrhythmias; the Ca(2+)-overload after Na+ loading elicited by aconitine is not likely to be mediated by increased Ca2+ influx through a slow channel.

Aconitine

Electrophysiological effects of aconitine in rat hippocampal slices.

The electrophysiological effects of aconitine were investigated in the rat hippocampal slice and compared with those of veratridine. Both alkaloids are known to bind at site 2 of sodium channels and to block its inactivation. Extracellular recordings revealed that aconitine and veratridine exert inhibitory effects on neuronal excitability. Aconitine slowly and reversibly decreased the population spike recorded in the CA1 pyramidal cell layer. The reduction of the spike amplitude was similar whether orthodromically or antidromically activated. The aconitine-induced inhibition did not differ from that of veratridine. However, following washout of aconitine, the amplitude of the antidromic spike was increased compared to the control amplitude. The veratridine-induced inhibition was only partially reversible. This inhibition was also observed during suppression of synaptic transmission by a low Ca2+/high Mg2+-medium, indicating an inhibition of axonal conductance. The results show that in the absence of synaptic transmission the antidromic (alvear) spike is more sensitive to the inhibitory action of aconitine than the presynaptic fiber spike elicited by stimulation of the Schaffer collaterals. Furthermore, it is shown that aconitine acts in an activity-dependent manner, in that the latency of onset of the inhibition is prolonged when the stimulation frequency is decreased. Field excitatory postsynaptic potentials were also suppressed by aconitine, whereas excitatory postsynaptic currents recorded by the patch clamp technique were not influenced by aconitine when cells were held at -60 mV.

Aconitine

Gating and selectivity of aconitine-modified sodium channels in neuroblastoma cells.

Currents through normal and aconitine-modified sodium channels in perfused neuroblastoma cells were measured under voltage-clamp conditions. Aconitine is shown to induce changes in channel selectivity so that channels become more permeable to NH4+ than to Na+. Aconitine induces the shift of voltage dependence of channel activation toward more negative potentials by about 20 mV. Aconitine-modified channels inactivate practically completely with a time-course similar to that for normal channels. Aconitine is effective when applied to either side of the membrane. Steady-state characteristics of the gating machinery of aconitine-modified channels are discussed in terms of three-state model. According to the model, aconitine increases the probability of finding the channel in open state, which is reflected in negative shift of the voltage dependence of activation. The model predicts that the larger this shift, the higher is the level of steady-state sodium conductance. The comparison of respective properties of aconitine-modified channels in neuroblastoma cell and frog nerve confirms this prediction. Aconitine is assumed to reach its receptor through the lipophilic part of the membrane.

Aconitum

Potentiation by higenamine of the aconitine-induced positive chronotropic effect in isolated right atria of mice: the effects of cholera toxin, forskolin and pertussis toxin.

Aconitine and higenamine are the major cardioactive compounds obtained from processed aconite. The chronotropic interaction between these two compounds was investigated in isolated right atria of mice. Both aconitine and higenamine potentiated the action of the other. Practolol (1 nM), a selective beta 1-adrenergic antagonist, but not butoxamine (1 microM), a beta 2-adrenergic antagonist, blocked the potentiation by higenamine (5 nM) of the aconitine-induced positive chronotropic effect and, at high concentrations (30 and 300 nM) also shifted the aconitine concentration-response curves to the right. The potentiating interaction between aconitine and higenamine was reversed by pretreating with cholera toxin (CTX) and forskolin. In CTX (100 nM, 1 h)- and forskolin (30 and 100 nM)-treated atria, higenamine significantly depressed the aconitine-induced response, which was abolished by pertussis toxin (PTX, 150 micrograms/kg, i.p., 3 d). Neither CTX (50 and 100 nM) nor forskolin (15-100 nM) significantly affected the aconitine-induced positive chronotropic effect, while PTX (150 micrograms/kg) depressed it. These results suggest that the potentiating interaction between aconitine and higenamine involves "cross-talk" between the beta 1-adrenergic signalling pathway and Gi-protein.

Aconitine

Aconitine-induced delayed afterdepolarization in frog atrium and guinea pig papillary muscles in the presence of low concentrations of Ca2+.

Aconitine will induce arrhythmias after the fiber has been completely repolarized. This arrhythmia is generally facilitated in the presence of high Ca2+ solution, yet the aconitine-induced arrhythmia occurs even in the presence of low Ca2+ solutions. We studied aconitine-induced arrhythmia (particularly the amplitude of delayed afterdepolarization) in the frog atrium or guinea-pig papillary muscles in Ca2+-free solution, in the presence or absence of Ca2+ channel blocking agents. In Ca2+-free solution, aconitine (10(-5) g/ml) decreased the resting potential, overshoot, Vmax, and shortened the duration of the 90% action potential, before the onset of delayed afterdepolarization in frog atrial preparations. Tetrodotoxin (TTX) (2 X 10(-7) g/ml) blocked these aconitine-induced electrical changes. Verapamil (10(-6) g/ml) in nominally Ca2+-free solution blocked neither the generation of delayed afterdepolarization nor the triggered activity, while LaCl3 (0.5 mM) or TTX halted it. Delayed afterdepolarization appeared following the aconitine-induced transient increase in twitch tension. This transient increase in twitch tension was blocked by LaCl3 and TTX but not by verapamil. Delayed afterdepolarization in Ca2+-free solution demonstrated the voltage dependence of a U shape between -40 and -80 mV and was inhibited by low Na+ and high K+. Under the influence of aconitine in the guinea pig papillary muscle exposed to the Ca2+-free solution, depolarizing clamp pulses produced a transient inward current, and here the sigmoid time- and voltage-dependent characteristics were similar to those seen in the case of digitalis intoxication. These results suggest that intracellular Na+ loading plays an important role in the aconitine-induced delayed afterdepolarization and transient inward currents in low Ca2+ solution.

Aconitine

Gating current experiments on frog nodes of Ranvier treated with Centruroides sculpturatus toxins or aconitine.

(1) Gating currents were recorded from frog nodes of Ranvier treated either with toxins III or IV from the venom of the scorpion Centruroides sculpturatus or with the alkaloid toxin aconitine. (2) Toxins III or IV from Centruroides sculpturatus (which drastically reduce the sodium permeability PNa and slightly shift its voltage dependence in the depolarizing direction) caused a small depolarizing shift of the relation between charge (Qon) and membrane potential (E) without affecting the maximum charge Qon max. (3) On nodes treated with toxins III or IV from Centruroides sculpturatus, a depolarizing conditioning pulse (which transiently shifts the descending branch of the INa(E) curve by up to 60 mV in the hyperpolarizing direction) shifted the midpoint potential (Emid) of the Qon(E) curve by -17 mV and slightly increased the slope of the curve; it also decreased Qon max markedly but had little effect on Qon measured with small depolarizing pulses. By contrast, massive treatment with aconitine (which irreversibly shifts sodium activation in the hyperpolarizing direction) irreversibly shifted the midpoint potential of the Qon(E) curve from -28.5 to -69 mV and significantly increased Qon and Qoff measured with small depolarizing pulses; concomitantly, the voltage dependence of the on time constant of the charge movement [tau on(E)] was shifted by -44 mV. (4) The sodium current INa was exponential both in nodes treated with toxins III or IV of Centruroides sculpturatus and subjected to a depolarizing conditioning pulse and in aconitine-treated nodes; in the latter, INa started after a delay of 30-40 microseconds. The time constant of the sodium current. tau on Na, was larger than the time constant of the charge movement, tau on Q; the ratio tau on Q/tau on Na was 0.61 and 0.73 in the experiments with Centruroides sculpturatus toxins and aconitine, respectively. (5) The off time constant of the sodium current (tau off Na) was slightly increased in nodes treated with Centruroides sculpturatus toxins and subjected to a depolarizing conditioning pulse, whereas it was markedly increased in aconitine-treated nodes. With the former treatment, the off time constant of the charge movement (tau off Q) was unaffected but with aconitine treatment it was considerably increased although it remained smaller than tau off Na. Consequently, the ratio tau off Q/tau off Na (which is greater than or equal to 1 in untreated nodes) became smaller than one, reaching values as low as 0.58 and 0.44 in the experiments with Centruroides sculpturatus toxins and aconitine, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Aconitine

Blocking effects of hypaconitine and aconitine on nerve action potentials in phrenic nerve-diaphragm muscles of mice.

The mechanisms of neuromuscular blockade by hypaconitine and aconitine were investigated electrophysiologically in isolated phrenic nerve-diaphragm muscles of mice. Hypaconitine (0.08-2 microM) and aconitine (0.3-2 microM) depressed the nerve-evoked twitch tension, without affecting the contraction evoked by stimulation of the muscle. At the concentrations of hypaconitine (up to 5 microM) and aconitine (up to 2 microM) that depressed the nerve-evoked twitch tension, the resting membrane potential of the muscle cells was unchanged. Hypaconitine (0.1-2 microM) and aconitine (2 microM) blocked the end-plate potential (epp), without affecting the amplitude of the miniature epp (mepp). The quantal content of end-plate potentials was decreased by these agents in parallel with the decrement in amplitude. The nerve compound action potential was inhibited by hypaconitine (5 microM) and aconitine (2-10 microM), as well as by 1 microM tetrodotoxin (TTX). When the nerve compound action potential was completely blocked by 2 microM aconitine, the muscle action potential was unaffected, although 1 microM TTX suppressed both potentials to the same degree. These results indicate the neuromuscular blockade produced by hypaconitine and aconitine were caused by reducing the evoked quantal release. The mechanism of this effect was attributed mainly to blocking of the nerve compound action potential.

Aconitine

Studies on the constituents of Aconitum species. IX. The pharmacological properties of pyro-type aconitine alkaloids, components of processed aconite powder 'kako-bushi-matsu': analgesic, antiinflammatory and acute toxic activities.

Eight pyro-type aconitine alkaloids contained in the processed aconite powder 'Kako-bushi-matsu' were studied for their analgesic, antiinflammatory and acute toxic actions. All these compounds showed significant analgesic and antiinflammatory actions. Among the pyro-type alkaloids, 16-epi-pyrojesaconitine and pyrojesaconitine were the most potent analgesics. The analgesic activity of pyro-type aconitine alkaloids was lower than that of each of the parent alkaloids, aconitine, mesaconitine, hypaconitine and jesaconitine. However, pyro-type aconitine alkaloids had very low toxicity, and the decreasing rates of the toxicity in changing from the parent alkaloids to the pyro-type aconitine alkaloids were much larger than those relating to the analgesic activity. Eight pyro-type aconitine alkaloids were found to inhibit the carrageenin-induced hind paw edema at 2 to 6 h after the carrageenin subplantar injection. Consequently, it was demonstrated that the pyro-type aconitine alkaloids produced through the processing of raw aconite roots, 'Bushi', have a role in the medicinal effects of the processed aconite powder 'Kako-bushi-matsu'.

Aconitine

Hemodynamic and arrhythmogenic effects of aconitine applied to the left atria of anesthetized cats. Effects of amiodarone and atropine.

The arrhythmogenic and hemodynamic effects of 0.04% aconitine solution applied locally to the left atria of cats and the effects of amiodarone (10 mg/kg) and atropine (0.2 mg/kg) on the responses to aconitine were investigated. Cats were anesthetized with sodium pentobarbital. The left atrial and limb lead electrocardiograms and the arterial pressure were recorded. Cardiac output was determined with the thermo dilution technique. Aconitine nitrate induced dysrhythmias lasting for a mean of 111 min. Atrial fibrillation occurred in 47% of the animals. A long-lasting (at least 3 hr) cardiodepressant action was seen in response to aconitine. Pretreatment with atropine largely prevented the hemodynamic effects of aconitine and prevented fibrillation. However, mean maximum atrial rates recorded during successive 5 min intervals were similar in control and atropine-treated animals. Amiodarone suppressed dysrhythmias in both atropine-treated and nontreated animals at a dose which exerted only minimal cardiodepression. The method described for evaluating potential activity against supraventricular dysrhythmias in the cat is relatively simple, reproducible, and suitable for statistical analyses. Aconitine appears to exert a long-lasting cholinergic action which may be involved in the genesis of aconitine-induced atrial fibrillation.

Aconitine

Effects of magnesium on polymorphic ventricular tachycardias induced by aconitine.

We examined the effects of Mg2+ on aconitine-induced polymorphic ventricular tachycardias (PVT) in excised rabbit hearts under Langendorff perfusion and in Purkinje-muscle preparations. Local electrograms using bipolar electrodes and transmembrane potentials with the microelectrode technique were recorded from Langendorff hearts and Purkinje-muscle preparations, respectively. In Langendorff preparations, intracoronary application of 0.1 microM aconitine induced PVT 28.8 +/- 3.4 min after development of regular monomorphic ventricular tachycardias (MVT) in all 18 preparations. Application of 5 and 10 mM Mg2+ restored aconitine-induced PVT to sinus rhythm after 26.8 +/- 3.4 min (n = 9), but < 3 mM Mg2+ was not effective in restoring of sinus rhythm. Increased Mg2+ concentrations < or = 5 mM in the coronary perfusate prevented development of PVT by aconitine. Intracoronary application of 10 microM tetrodotoxin (TTX) also restored aconitine-induced PVT to sinus rhythm after 3.2 +/- 0.8 min (n = 4). Although applications of 50 microM lidocaine, 10 microM flecainide, or 1 microM verapamil could change PVT to MVT, they were not effective in restoring sinus rhythm. In Purkinje-muscle preparations, spontaneous action potentials (AP) from slow diastolic depolarization appeared after aconitine at the maximum diastolic potential of -75.0 +/- 3.7 mV in Purkinje fibers and were conducted to ventricular muscles (n = 5). Spontaneous activity gradually increased in rate and then developed triggered activity arising from early after depolarization (EAD). EAD induced by aconitine always appeared first in Purkinje fibers and later in muscle fibers. Once triggered activities started from EAD, rate, rhythm and amplitudes of APs became fast and variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Aconitine

Aconitine, a main component of aconite, increases spontaneous acetylcholine release from the frontal cerebral cortex of freely moving rats.

We investigated whether peripherally administered aconitine increases spontaneous acetylcholine (ACh) release from the frontal cerebral cortex in freely moving rats using in vivo microdialysis, as it relates to aconitine-induced bradycardia estimated by a tail-artery cuff technique in unilateral anterior hypothalamus (AH)-lesion mice. Intraperitoneally administered aconitine significantly increased cortical ACh release within 15 min at 10 and 30 micrograms/kg. The increasing effect disappeared 30 min after the administration of aconitine. Aconitine-induced ACh release was not inhibited by intracerebroventricularly preadministered atropine (1 and 3 micrograms/rat). Atropine (1 micrograms/mouse) preadministered into the contralateral intact AH in mice did not affect aconitine (30 micrograms/kg, i.p.)-induced bradycardia. These results indicate that the cortical ACh release caused by peripherally administered aconitine does not occur through activation of the central muscarine receptor, and thus its ACh release may not be concerned with the occurrence of bradycardia.

Acetylcholine

The influence of tetrodotoxin on the toxic effects of aconitine in vivo.

Both aconite toxins (aconitine, mesaconitine, and hypaconitine) and a pufferfish toxin (tetrodotoxin, TTX) were detected in the blood of a legal autopsy case. In order to elucidate the in vivo influence of TTX on the toxic effects of aconitine, a mixture of aconitine and TTX was administered to male ICR mice orally or intraperitoneally. The animal experiments revealed that the time of death due to aconitine was significantly delayed in proportion to the dose of TTX compared with the case for aconitine alone, and that the mortality of aconitine was lowered by TTX when the dose ratio of the two toxins was in a particular range. Accordingly, it is thought that the toxic effects of aconitine are attenuated by TTX in vivo.

Aconitine

Effects of aconitine and batrachotoxin on Na currents and gating currents in the frog node of Ranvier.

The effects of aconitine and batrachotoxin (BTX) on Na currents and gating currents were studied on voltage clamped frog nodes of Ranvier. The relation between steady-state values of charge movement and test pulse potential (Q-E) was compared with the fraction of open channels at a given potential (F-E). In aconitine-treated nodes the half potential, Emid, of the F-E curve was -87 mV and the slope factor, k, was 6.6 mV. Compared to normal nodes aconitine shifted the F-E curve by -53 mV along the voltage axis without significantly altering the slope. The parameters of the Qon-E curve of aconitine-treated nodes were Emid = -63 mV and k = 18.8 mV compared with Emid = -30 mV and k = 17 mV in a normal node. For the Qoff-E curve Emid was -76 mV, fairly close to Emid of the F-E curve, but the slope remained much smaller than that of the F-E curve. Thus, in aconitine-treated nodes, the normalized Qon-E and Qoff-E curves stay below the F-E curve over almost the whole potential range, a situation different from that in untreated or chloramine-T-treated nodes (Drews 1987). Similar results were obtained with BTX. The F-E curve of BTX-treated fibres had a half potential Emid = -85.1 mV and a slope factor k = 4.7 mV. In contrast to aconitine-treated nodes, the F-E curve showed a secondary rise at E greater than -50 mV.(ABSTRACT TRUNCATED AT 250 WORDS)

Aconitine

Age-dependent differences in sensitivity to aconitine of rat hippocampal slices.

The effect of aconitine, a plant alkaloid known to bind at site 2 of the sodium channel, was investigated on neuronal excitability in hippocampal slices of adult and juvenile rats. Aconitine (0.01-1 microM) diminished the extracellularly recorded population spike in a concentration-dependent manner. At each concentration, the inhibitory action of aconitine was significantly stronger and was obtained after a shorter latency in slices of juvenile rats (20-25 days) as compared with slices of adult rats (45-50 days). When maximal inhibition was achieved, a prolonged application of aconitine evoked an increase in spike amplitude of up to 15% in slices of juvenile but not of adult rats. The latency of recovery from the aconitine-induced inhibition was also significantly shorter in slices of juvenile rats. This effect was concentration-dependent and significantly stronger in slices of juvenile rats. These observations indicate that juvenile hippocampi have a higher susceptibility to the effect of aconitine, but also provide a partial protective mechanism.

Aconitine

Different actions of aconitine and veratrum alkaloids on frog skeletal muscle.

1. The electrophysiological effects of veratridine, cevadine and aconitine (10(-8)-2 x 10(-4), 2 x 10(-7)-2 x 10(-6) and 2 x 10(-6)-10(-4) mol/l, respectively) were compared on frog muscle membrane using conventional microelectrodes. 2. Veratridine and aconitine were equally effective in depolarizing the resting membrane with the threshold concentration of 5 x 10(-5) mol/l. 3. Volleys of repetitive discharges and slow transient depolarizations were observed when single electrical stimuli were applied in the presence of veratridine (5 x 10(-8)-2 x 10(-5) mol/l), but not aconitine. Volleys with aconitine could be evoked only by repetitive stimulation; however no tendency of repolarization was observed following these volleys. Two orders of magnitude more aconitine than veratridine was required to induce volleys with similar parameters. 4. The effects of cevadine were similar to those of the corresponding concentrations of veratridine. 5. The observed differences between the electrophysiological actions of aconitine and veratrum alkaloids may be explained in part with differences in Na+ channel inactivation produced by these toxins, in addition to differences in their use-dependent behavior.

Aconitine

Fatal accidental aconitine poisoning following ingestion of Chinese herbal medicine: a report of two cases.

Two Hong Kong Chinese adults were prescribed aconitine-containing herbal preparations by Chinese herbal practitioners for relief of minor musculoskeletal pain. After ingestion both quickly developed ventricular tachycardia followed by ventricular fibrillation and cardiac arrest refractory to resuscitation; death in both cases occurred within 12 h of ingestion. Neither had a history of cardiac disease. Coroners' autopsies showed no significant macroscopic or microscopic findings, with no evidence of ischaemic heart disease or other cardiac disease. Toxicological examination of stomach contents showed a trace of hydrolysed aconitine in one case but was negative in the other. Analysis of the herbal preparations consumed, however, confirmed the presence of the aconitine-containing herbs in quantities greatly in excess of the maximum recommended in the P.R. China pharmacopoeia. Both patients therefore consumed an accidental overdose of aconitine, which has a narrow safety margin between therapeutic analgesic effect and its known cardiotoxic effect. These particular herbal medicines are controlled substances in mainland China and Taiwan, but no controls on their dispensing exist in Hong Kong. Together with reported non-fatal cases of aconitine poisoning, these cases emphasise that legal controls of the dispensing and use of aconitine-containing herbal preparations are necessary in Hong Kong.

Aconitine