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      Aconite poisoning

      Clinical toxicology
      Informa UK Ltd.

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          Aconitum sp. alkaloids: the modulation of voltage-dependent Na+ channels, toxicity and antinociceptive properties.

          Alkaloids from Aconitum sp., used as analgesics in traditional Chinese medicine, were investigated to elucidate their antinociceptive and toxic properties considering: (1) binding to Na+ channel epitope site 2, (2) alterations in synaptosomal Na+ and Ca2+ concentration ([Na+]i, [Ca2+]i), (3) arrhythmogenic action of isolated atria, (4) antinociceptive and (5) acute toxic action in mice. The study revealed a high affinity group (Ki 1 microM) and a low affinity group (Ki 10 microM) of alkaloids binding to site 2. The compounds of the high affinity group induce an increase in synaptosomal [Na+]i and [Ca2+]i (EC50 3 microM), are antinociceptive (ED50, 25 microg/kg), provoke tachyarrhythmia and are highly toxic (LD50 70 microg/kg), whereas low affinity alkaloids reduce [Ca2+]i, induce bradycardia and are less antinociceptive (ED50 20 mg/kg) and less toxic (LD50 30 mg/kg). These results suggest that the alkaloids can be grouped in Na+ channel activating and blocking compounds, but none of the alkaloids seem to be suitable as analgesics because of the low LD50/ED50 values.
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            Cardiotoxicity after accidental herb-induced aconite poisoning.

            Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. The rootstocks of Aconitum plants, which contain aconite alkaloids, have been common components of Chinese herbal recipes. We have documented life-threatening intoxication in 17 Chinese subjects after accidental herb-induced aconite poisoning. All patients developed symptoms of aconite toxicity within 2 h of herb ingestion. Most developed tachyarrhythmias, including ventricular tachycardia and fibrillation from which 2 patients died. Toxicological evaluation revealed that aconites from the Aconitum rootstocks were the only plausible casual factor for intoxication. These cases point to the need for strict surveillance of herbal substances with low safety margins.
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              Clinical features and management of herb-induced aconitine poisoning

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                Journal
                10.1080/15563650902904407

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