Aconitum toxicity - Revision history

Danbot: Add verified PubMed references (PMIDs 19514874, 22469654)

2026-03-22T10:53:58Z

Add verified PubMed references (PMIDs 19514874, 22469654)

← Revisión anterior		Revisión del 10:53 22 mar 2026
Línea 2:		Línea 2:
	[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]		[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]
	[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]		[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]
	*''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons		*''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons<ref>Chan TY. Aconite poisoning. Clin Toxicol (Phila). 2009 Apr;47(4):279-85. PMID 19514874</ref>
	*In the US, it is not a commonly ingested flower, but is responsible for significant morbidity and mortality		*In the US, it is not a commonly ingested flower, but is responsible for significant morbidity and mortality
	**Most poisonous flower ingestions are accidental ingestions by children, which account for roughly 2% of all toxic exposures		**Most poisonous flower ingestions are accidental ingestions by children, which account for roughly 2% of all toxic exposures
Línea 29:		Línea 29:
	**[[Hypotension]]		**[[Hypotension]]
	**[[Bradycardia]]		**[[Bradycardia]]
	**[[Arrhythmias]]- most common cause of mortality, include:		**[[Arrhythmias]]- most common cause of mortality, include:<ref>Chan TY. Aconitum alkaloid content and the high toxicity of aconite tincture. Forensic Sci Int. 2012 Oct 10;222(1-3):1-3. PMID 22469654</ref>
	***[[Heart block]]		***[[Heart block]]
	***Ectopic beats		***Ectopic beats

ClaireLewis: /* Clinical Features */

2019-09-28T17:06:34Z

Clinical Features

← Revisión anterior		Revisión del 17:06 28 sep 2019
Línea 31:		Línea 31:
	**[[Arrhythmias]]- most common cause of mortality, include:		**[[Arrhythmias]]- most common cause of mortality, include:
	***[[Heart block]]		***[[Heart block]]
	***[[Ectopic beats]]		***Ectopic beats
	***[[Supraventricular tachycardia]]		***[[SVT\|Supraventricular tachycardia]]
	***[[Bundle branch block]]		***[[Bundle branch block]]
	***Junctional escape rhythms		***Junctional escape rhythms

ClaireLewis at 17:06, 28 September 2019

2019-09-28T17:06:12Z

← Revisión anterior		Revisión del 17:06 28 sep 2019
Línea 2:		Línea 2:
	[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]		[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]
	[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]		[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]
	''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the ~~United States~~, ~~most~~ poisonous flower ingestions are accidental ingestions by children ~~and~~ account for roughly 2% of all toxic exposures~~; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide.~~ Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids ~~bind~~ to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.		*''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons
			*In the US, it is not a commonly ingested flower, but is responsible for significant morbidity and mortality
			**Most poisonous flower ingestions are accidental ingestions by children, which account for roughly 2% of all toxic exposures
			**Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are [[suicide\|suicidal attempts]]
			**A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant
			**All parts of Aconitum are toxic, with the roots being most toxic
			**Toxicity is due to Aconite alkaloids
			**Bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels.
			*Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.

	==Clinical Features==		==Clinical Features==
Línea 11:		Línea 19:
	*Neurotoxicity toxicity		*Neurotoxicity toxicity
	**[[Dizziness]]		**[[Dizziness]]
	**Perioral paresthesia		**Perioral [[paresthesia]]
	**Visual impairment		**Visual impairment
	**[[Ataxia ]]		**[[Ataxia]]
	**Paralysis		**[[weakness\|Paralysis]]
	**[[Seizures]]		**[[Seizures]]
	**Coma		**[[Coma]]
	*Cardiotoxicity		*Cardiotoxicity
	**May present with chest pain, palpitations, and syncope		**May present with chest pain, palpitations, and syncope
	**[[Hypotension]]		**[[Hypotension]]
	**[[Bradycardia]]		**[[Bradycardia]]
	**~~Most~~ common cause of mortality ~~are arrhythmias which~~ include ~~heart~~ block~~, ectopic~~ beats~~, supraventricular~~ tachycardia~~, bundle~~ branch block~~, junctional~~ escape rhythms~~, ventricular~~ tachycardia, bifascicular ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes~~, ventricular~~ fibrillation~~, and asystole~~		**[[Arrhythmias]]- most common cause of mortality, include:
			***[[Heart block]]
			***[[Ectopic beats]]
			***[[Supraventricular tachycardia]]
			***[[Bundle branch block]]
			***Junctional escape rhythms
			***[[Ventricular tachycardia]], bifascicular ventricular tachycardia, [[polymorphic ventricular tachycardia]], [[torsades de pointes]]
			***[[Ventricular fibrillation]]
			***[[Asystole]]
	**Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids		**Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids
	*Respiratory toxicity		*Respiratory toxicity
	**Respiratory muscle paralysis often necessitates intubation or leads to death		**[[respiratory failure\|Respiratory muscle paralysis]] often necessitates [[intubation]] or leads to death

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 30:		Línea 46:
	[[File:Death Camas.jpg\|thumbnail\|Zigadenus glaberrimus (Sandbog Death Camas) has a similar toxic profile as aconitum]] [[File:Larkspur.jpg\|thumbnail\|Delphinium (Larkspur) has a similar toxic profile as aconitum]]		[[File:Death Camas.jpg\|thumbnail\|Zigadenus glaberrimus (Sandbog Death Camas) has a similar toxic profile as aconitum]] [[File:Larkspur.jpg\|thumbnail\|Delphinium (Larkspur) has a similar toxic profile as aconitum]]
	[[File:Foxglove.jpg\|thumbnail\|Digitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity]]		[[File:Foxglove.jpg\|thumbnail\|Digitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity]]
	*Accidental Ingestion vs ~~Suicidal~~ attempt		*Accidental Ingestion vs [[suicide\|suicide attempt]]
	*Aconitum Poisoning		*Aconitum Poisoning
	*Other toxic plant ingestion		*Other toxic plant ingestion
	**Including plants with similar symptoms and management such as ''Veratrum'' spp (American hellebore), ''Zigadenus'' spp (Death Camas), and ''Delphinium'' spp (Larkspur) the former two of which are often mistakenly ingested due to their similarity to non-toxic, edible plants		**Including plants with similar symptoms and management such as ''Veratrum'' spp (American hellebore), ''Zigadenus'' spp (Death Camas), and ''Delphinium'' spp (Larkspur) the former two of which are often mistakenly ingested due to their similarity to non-toxic, edible plants
	*Non-toxic plant ingestion		*Non-toxic plant ingestion
	*Cardiac ~~Glycoside Ingestion~~		*Cardiac glycoside ingestion
	**~~Including both pharmaceuticals and~~ ''digitalis'' (Foxglove), which is similar in appearance to Aconitum		**[[Digoxin toxicity\|Digoxin]] or ''[[digitalis toxicity\|digitalis]]'' (Foxglove), which is similar in appearance to Aconitum

	==Evaluation==		==Evaluation==
	*[[EKG]]		*[[EKG]]
	*Elevated CPK and [[troponin]] levels with or without myocardial infarction may occur		*Elevated CPK and [[troponin]] levels with or without myocardial infarction may occur
	*Hypokalemia often noted		*[[Hypokalemia]] often noted
	*Acid-base disorder including [[respiratory acidosis]], [[respiratory alkalosis]], and [[metabolic acidosis]] common		*Acid-base disorder including [[respiratory acidosis]], [[respiratory alkalosis]], and [[metabolic acidosis]] common
	*Hepatic and renal impairment are common		*[[hepatic failure\|Hepatic]] and [[renal failure\|renal impairment]] are common

	==Management==		==Management==
	*GI ~~Symptoms~~		*GI symptoms
	**Administration of [[activated charcoal]] (0.5-1.0 gm/kg up to 50g) within 1 hour		**Administration of [[activated charcoal]] (0.5-1.0 gm/kg up to 50g) within 1 hour
	***No prospective studies so recommendations are case dependent		***No prospective studies so recommendations are case dependent
Línea 52:		Línea 68:
	**[[Gastric lavage]]		**[[Gastric lavage]]
	***Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested		***Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
	**Osmotic laxatives		**Osmotic [[laxatives]]
	**If in austere environment with limited resources and delayed extraction time:		**If in austere environment with limited resources and delayed extraction time:
	***0.5 ounces (15mL) [[Syrup of Ipecac]] orally with 500mL of water		***0.5 ounces (15mL) [[Syrup of Ipecac]] orally with 500mL of water
	***Manual induction of vomiting		***Manual induction of vomiting
			*Cardiotoxic effects
	*Cardiotoxic ~~Effects~~
	**Hypotension		**Hypotension
	***[[IV fluids]]		***[[IV fluids]]
Línea 63:		Línea 78:
	**[[Bradycardia]]		**[[Bradycardia]]
	***[[Atropine]]		***[[Atropine]]
	**[[~~Arrthymias~~]]		**[[Arrhythmias]]
	***Monitor patient on telemetry until 24hrs after symptomatic resolution		***Monitor patient on telemetry until 24hrs after symptomatic resolution
	***[[Lidocaine]], [[procainamide]], [[flecainide]], or [[amiodarone]]		***[[Lidocaine]], [[procainamide]], [[flecainide]], or [[amiodarone]]
			*Neurotoxic effects
	*Neurotoxic ~~Effects~~
	**[[Seizure]] activity		**[[Seizure]] activity
	***[[Benzodiazepines]]		***[[Benzodiazepines]]
			*Respiratory failure
	*Respiratory ~~Failure~~
	**May require intubation and mechanical ventilation		**May require intubation and mechanical ventilation
			*Suicidal ideation
	*Suicidal ~~Ideation~~
	**Obtain detailed history as to why plant was ingested		**Obtain detailed history as to why plant was ingested
	**If suicidal ideation is suspected, consider psychiatric referral		**If suicidal ideation is suspected, consider psychiatric referral

Rossdonaldson1: /* Clinical Features */

2019-05-17T03:46:30Z

Clinical Features

← Revisión anterior		Revisión del 03:46 17 may 2019
Línea 8:		Línea 8:
	*Symptom onset typically between 3 minutes and 6 hours after ingestion with gradual progression of severity		*Symptom onset typically between 3 minutes and 6 hours after ingestion with gradual progression of severity
	*Nonspecific GI symptoms		*Nonspecific GI symptoms
	**Nausea, vomiting, diarrhea		**[[Nausea]], [[vomiting]], [[diarrhea]]
	*Neurotoxicity toxicity		*Neurotoxicity toxicity
	**Dizziness		**[[Dizziness]]
	**Perioral paresthesia		**Perioral paresthesia
	**Visual impairment		**Visual impairment
	**Ataxia		**[[Ataxia ]]
	**Paralysis		**Paralysis
	**Seizures		**[[Seizures]]
	**Coma		**Coma
	*Cardiotoxicity		*Cardiotoxicity
	**May present with chest pain, palpitations, and syncope		**May present with chest pain, palpitations, and syncope
	**Hypotension		**[[Hypotension]]
	**Bradycardia		**[[Bradycardia]]
	**Most common cause of mortality are arrhythmias which include heart block, ectopic beats, supraventricular tachycardia, bundle branch block, junctional escape rhythms, ventricular tachycardia, bifascicular ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes, ventricular fibrillation, and asystole		**Most common cause of mortality are arrhythmias which include heart block, ectopic beats, supraventricular tachycardia, bundle branch block, junctional escape rhythms, ventricular tachycardia, bifascicular ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes, ventricular fibrillation, and asystole
	**Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids		**Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids
	*Respiratory ~~Toxicity~~		*Respiratory toxicity
	**Respiratory muscle paralysis often necessitates intubation or leads to death		**Respiratory muscle paralysis often necessitates intubation or leads to death

Rossdonaldson1 at 03:44, 17 May 2019

2019-05-17T03:44:43Z

← Revisión anterior		Revisión del 03:44 17 may 2019
Línea 1:		Línea 1:
	~~==Aconitum Ingestion==~~		==Background==
	===Background===
	''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the United States, most poisonous flower ingestions are accidental ingestions by children and account for roughly 2% of all toxic exposures; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide. Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.

	[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]		[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]

	[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]		[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]
			''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the United States, most poisonous flower ingestions are accidental ingestions by children and account for roughly 2% of all toxic exposures; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide. Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.

	==Clinical Features==		==Clinical Features==
Línea 30:		Línea 27:

	==Differential Diagnosis==		==Differential Diagnosis==
			[[File:Veratrum Viridae.jpg\|thumbnail\|Veratrum Viridae (False Hellebore) has a similar toxic profile as aconitum]]
			[[File:Death Camas.jpg\|thumbnail\|Zigadenus glaberrimus (Sandbog Death Camas) has a similar toxic profile as aconitum]] [[File:Larkspur.jpg\|thumbnail\|Delphinium (Larkspur) has a similar toxic profile as aconitum]]
			[[File:Foxglove.jpg\|thumbnail\|Digitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity]]
	*Accidental Ingestion vs Suicidal attempt		*Accidental Ingestion vs Suicidal attempt
	*Aconitum Poisoning		*Aconitum Poisoning
Línea 37:		Línea 37:
	*Cardiac Glycoside Ingestion		*Cardiac Glycoside Ingestion
	**Including both pharmaceuticals and ''digitalis'' (Foxglove), which is similar in appearance to Aconitum		**Including both pharmaceuticals and ''digitalis'' (Foxglove), which is similar in appearance to Aconitum

	[[File:Veratrum Viridae.jpg\|thumbnail\|Veratrum Viridae (False Hellebore) has a similar toxic profile as aconitum]] [[File:Death Camas.jpg\|thumbnail\|Zigadenus glaberrimus (Sandbog Death Camas) has a similar toxic profile as aconitum]] [[File:Larkspur.jpg\|thumbnail\|Delphinium (Larkspur) has a similar toxic profile as aconitum]] [[File:Foxglove.jpg\|thumbnail\|Digitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity]]

	==Evaluation==		==Evaluation==
	*EKG		*[[EKG]]
	*Elevated CPK and troponin levels with or without myocardial infarction may occur		*Elevated CPK and [[troponin]] levels with or without myocardial infarction may occur
	*Hypokalemia often noted		*Hypokalemia often noted
	*Acid-base disorder including ~~Respiratory~~ acidosis, ~~Respiratory~~ alkalosis, and metabolic acidosis common		*Acid-base disorder including [[respiratory acidosis]], [[respiratory alkalosis]], and [[metabolic acidosis]] common
	*Hepatic and renal impairment are common		*Hepatic and renal impairment are common

	==Management==		==Management==
	*GI Symptoms		*GI Symptoms
	**Administration of activated charcoal (0.5-1.0 gm/kg up to 50g) within 1 hour		**Administration of [[activated charcoal]] (0.5-1.0 gm/kg up to 50g) within 1 hour
	***No prospective studies so recommendations are case dependent		***No prospective studies so recommendations are case dependent
	***Avoid in patients actively vomiting or with altered mental status		***Avoid in patients actively vomiting or with altered mental status
	**Gastric ~~Lavage~~		**[[Gastric lavage]]
	***Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested		***Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
	**Osmotic ~~Laxatives~~		**Osmotic laxatives
	**If in austere environment with limited resources and delayed extraction time:		**If in austere environment with limited resources and delayed extraction time:
	***0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water		***0.5 ounces (15mL) [[Syrup of Ipecac]] orally with 500mL of water
	***Manual induction of vomiting		***Manual induction of vomiting

	*Cardiotoxic Effects		*Cardiotoxic Effects
	**Hypotension		**Hypotension
	***IV ~~Fluids~~		***[[IV fluids]]
	***Vasopressors if hypotension is persistent		***[[Vasopressors]] if hypotension is persistent
	**Bradycardia		**[[Bradycardia]]
	***Atropine		***[[Atropine]]
	**Arrthymias		**[[Arrthymias]]
	***Monitor patient on telemetry until 24hrs after symptomatic resolution		***Monitor patient on telemetry until 24hrs after symptomatic resolution
	***Lidocaine, procainamide, flecainide, or amiodarone		***[[Lidocaine]], [[procainamide]], [[flecainide]], or [[amiodarone]]

	*Neurotoxic Effects		*Neurotoxic Effects
	**Seizure ~~Activity~~		**[[Seizure]] activity
	***Benzodiazepines		***[[Benzodiazepines]]

	*Respiratory Failure		*Respiratory Failure
Línea 90:		Línea 88:
	#Chisholm, Hugh, ed. (1911). "Aconite" . Encyclopædia Britannica. 1 (11th ed.). Cambridge University Press. pp. 151–152		#Chisholm, Hugh, ed. (1911). "Aconite" . Encyclopædia Britannica. 1 (11th ed.). Cambridge University Press. pp. 151–152
	#USDA National Resources Conservation Services. Plant Profile Aconitum L. Monkshood https://plants.usda.gov/core/profile?symbol=ACONI. Accessed 4/26/2019.		#USDA National Resources Conservation Services. Plant Profile Aconitum L. Monkshood https://plants.usda.gov/core/profile?symbol=ACONI. Accessed 4/26/2019.


	[[Category:Toxicology]]		[[Category:Toxicology]]
	[[Category:Environmental]]		[[Category:Environmental]]

Rossdonaldson1: Rossdonaldson1 moved page Aconitum to Aconitum toxicity

2019-05-17T03:21:17Z

Rossdonaldson1 moved page Aconitum to Aconitum toxicity

← Revisión anterior	Revisión del 03:21 17 may 2019
(Sin diferencias)

Tricks: /* Differential Diagnosis */

2019-05-02T16:47:27Z

Differential Diagnosis

← Revisión anterior		Revisión del 16:47 2 may 2019
Línea 38:		Línea 38:
	**Including both pharmaceuticals and ''digitalis'' (Foxglove), which is similar in appearance to Aconitum		**Including both pharmaceuticals and ''digitalis'' (Foxglove), which is similar in appearance to Aconitum

	[[File:Veratrum Viridae.jpg\|thumbnail]] [[File:Death Camas.jpg\|thumbnail]] [[File:Larkspur.jpg\|thumbnail]] [[File:Foxglove.jpg\|thumbnail]]		[[File:Veratrum Viridae.jpg\|thumbnail\|Veratrum Viridae (False Hellebore) has a similar toxic profile as aconitum]] [[File:Death Camas.jpg\|thumbnail\|Zigadenus glaberrimus (Sandbog Death Camas) has a similar toxic profile as aconitum]] [[File:Larkspur.jpg\|thumbnail\|Delphinium (Larkspur) has a similar toxic profile as aconitum]] [[File:Foxglove.jpg\|thumbnail\|Digitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity]]

	==Evaluation==		==Evaluation==

Tricks: /* Background */

2019-05-02T16:43:29Z

Background

← Revisión anterior		Revisión del 16:43 2 may 2019
Línea 3:		Línea 3:
	''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the United States, most poisonous flower ingestions are accidental ingestions by children and account for roughly 2% of all toxic exposures; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide. Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.		''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the United States, most poisonous flower ingestions are accidental ingestions by children and account for roughly 2% of all toxic exposures; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide. Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.

	[[File:Aconite.jpg\|thumbnail]] [[File:Monkshood.jpg\|thumbnail]]		[[File:Aconite.jpg\|thumbnail\|Aconite]] [[File:Monkshood.jpg\|thumbnail\|Monkshood]]

	[[File:Map of American Aconitum Distribution.png\|thumbnail]]		[[File:Map of American Aconitum Distribution.png\|thumbnail\|A map of the distribution of Aconitum across the United States]]

	==Clinical Features==		==Clinical Features==

Tricks: Presentation and management of Aconitum ingestion

2019-04-26T23:07:51Z

Presentation and management of Aconitum ingestion

Página nueva

==Aconitum Ingestion==
===Background===
''Aconitum'' spp is a genus of over 250 flowering plants including Monkshood, Wolf's bane, Aconite, Leopard's bane, mousebane, blue rocket, and queen of poisons. In the United States, most poisonous flower ingestions are accidental ingestions by children and account for roughly 2% of all toxic exposures; aconitum is not a commonly ingested flower in the United States, though is responsible for significant morbidity and mortality worldwide. Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts. A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant. All parts of Aconitum are toxic, with the roots being most toxic. Toxicity is due to Aconite alkaloids bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels. Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.

[[File:Aconite.jpg|thumbnail]] [[File:Monkshood.jpg|thumbnail]]

[[File:Map of American Aconitum Distribution.png|thumbnail]]

==Clinical Features==
*Estimated lethal dose of wild plant is 1g
*Symptom onset typically between 3 minutes and 6 hours after ingestion with gradual progression of severity
*Nonspecific GI symptoms
**Nausea, vomiting, diarrhea
*Neurotoxicity toxicity
**Dizziness
**Perioral paresthesia
**Visual impairment
**Ataxia
**Paralysis
**Seizures
**Coma
*Cardiotoxicity
**May present with chest pain, palpitations, and syncope
**Hypotension
**Bradycardia
**Most common cause of mortality are arrhythmias which include heart block, ectopic beats, supraventricular tachycardia, bundle branch block, junctional escape rhythms, ventricular tachycardia, bifascicular ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes, ventricular fibrillation, and asystole
**Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids
*Respiratory Toxicity
**Respiratory muscle paralysis often necessitates intubation or leads to death

==Differential Diagnosis==
*Accidental Ingestion vs Suicidal attempt
*Aconitum Poisoning
*Other toxic plant ingestion
**Including plants with similar symptoms and management such as ''Veratrum'' spp (American hellebore), ''Zigadenus'' spp (Death Camas), and ''Delphinium'' spp (Larkspur) the former two of which are often mistakenly ingested due to their similarity to non-toxic, edible plants
*Non-toxic plant ingestion
*Cardiac Glycoside Ingestion
**Including both pharmaceuticals and ''digitalis'' (Foxglove), which is similar in appearance to Aconitum

[[File:Veratrum Viridae.jpg|thumbnail]] [[File:Death Camas.jpg|thumbnail]] [[File:Larkspur.jpg|thumbnail]] [[File:Foxglove.jpg|thumbnail]]

==Evaluation==
*EKG
*Elevated CPK and troponin levels with or without myocardial infarction may occur
*Hypokalemia often noted
*Acid-base disorder including Respiratory acidosis, Respiratory alkalosis, and metabolic acidosis common
*Hepatic and renal impairment are common

==Management==
*GI Symptoms
**Administration of activated charcoal (0.5-1.0 gm/kg up to 50g) within 1 hour
***No prospective studies so recommendations are case dependent
***Avoid in patients actively vomiting or with altered mental status
**Gastric Lavage
***Typically not recommended in most toxic ingestions due to risk of aspiration but applicable in plant ingestions because of large volume of organic material ingested
**Osmotic Laxatives
**If in austere environment with limited resources and delayed extraction time:
***0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water
***Manual induction of vomiting

*Cardiotoxic Effects
**Hypotension
***IV Fluids
***Vasopressors if hypotension is persistent
**Bradycardia
***Atropine
**Arrthymias
***Monitor patient on telemetry until 24hrs after symptomatic resolution
***Lidocaine, procainamide, flecainide, or amiodarone

*Neurotoxic Effects
**Seizure Activity
***Benzodiazepines

*Respiratory Failure
**May require intubation and mechanical ventilation

*Suicidal Ideation
**Obtain detailed history as to why plant was ingested
**If suicidal ideation is suspected, consider psychiatric referral

==Disposition==
*All patients suspected of aconitum ingestion should be admitted for 48 hours regardless of symptom presence due to sudden onset of severe symptoms

==References==
<references/>
#Graeme, Kimberlie A. "Ch. 65 Toxic Plant Ingestions." In Auerbach, Paul S.; Cushing, Tracy A.; Harris, N. Stuart. Auerbach's Wilderness Medicine (7th ed.).Philadelphia: Elsevier, Inc.
#"Poisoning." Forgey, William W. Wilderness Medicine Beyond First Aid (5th ed.). Guilford, Connecticut: The Globe Pequot Press.
#Adami, Francesco; Paganussi, Peter; Perone, Giovanna; Bera, Paola; Braga, Giosue; Concoreggi, Carlo. Recurrent Ventricular Arrhythmia Caused by Ingestion of ''Aconitum'' (Monkshood) Flowers. Wilderness & Environmental Medicine (2018); 29(4): 411-416.
#Chisholm, Hugh, ed. (1911). "Aconite" . Encyclopædia Britannica. 1 (11th ed.). Cambridge University Press. pp. 151–152
#USDA National Resources Conservation Services. Plant Profile Aconitum L. Monkshood https://plants.usda.gov/core/profile?symbol=ACONI. Accessed 4/26/2019.

[[Category:Toxicology]]
[[Category:Environmental]]