Aconitine Intoxication Following Ingestion of Folk Recipes Containing Aconitum Species

ABSTRACT

PURPOSE: Preparations of Aconitum roots in Chinese and Korean medicine are carefully prescribe for analgesic, antirheumatic and neurologic indications. However, in Korean folk medicine, a crude medical herb prepared from Aconitum is still used as form of a decoction or an unrefined tablet. Potential hazards of these medicinal herbs are poisoning and occasional fatalities due to low margins of safety. This study was conducted to document the adverse effects related to the use of these folk recipes that resulted in the emergency department (ED) admission. METHODS: A retrospective survey was conducted of 30 patients presented to the ED of a tertiary University Hospital with suspected adverse effects from folk recipes containing Aconitum over a three-year period from 1999 to 2001. The patients was analyzed according to sex, age, intention of use, residential area, vital signs on ED presentation, time to presentation, time to discharge or ECG normalization, frequency of chief complaints, and ECG abnormalities. RESULTS: The patients' mean age was around 67 years old. The patients were predominantly female (22 patients) and from rural areas (21 patients). The drug effects of Aconitum were not appreciated by almost all the patients. Of the chief complaints, nausea or vomiting was most common (76.7%). Time to presentation in the ED varied (30 ~ 930 minutes), which suggests that the occurrence of symptoms is directly related to the amount of aconitine in folk recipes containing Aconitum. Upon the arrival, most of the patients were hypotensive (MAP: 62 mmHg), but heart rates were normal or tachycardic. The ECG findings were variable, and, except for one case, normal sinus rhythm was restored within 24 hours without pharmacological intervention. CONCLUSION: This research demonstrates the need to emphasize public announcement to deter the injudicious use of folk recipes containing Aconitum species.