Something that makes homeopathic medicine unusual is that certain plants can be utilized as both medicine and poison. USDA National Resources Conservation Services.Recurrent Ventricular Arrhythmia Caused by Ingestion of Aconitum (Monkshood) Flowers. Adami, Francesco Paganussi, Peter Perone, Giovanna Bera, Paola Braga, Giosue Concoreggi, Carlo.
Guilford, Connecticut: The Globe Pequot Press. Wilderness Medicine Beyond First Aid (5th ed.). Auerbach's Wilderness Medicine (7th ed.).Philadelphia: Elsevier, Inc. 65 Toxic Plant Ingestions." In Auerbach, Paul S. All patients suspected of aconitum ingestion should be admitted for 48 hours regardless of symptom presence due to sudden onset of severe symptoms.If suicidal ideation is suspected, consider psychiatric referral.Obtain detailed history as to why plant was ingested.May require intubation and mechanical ventilation.Lidocaine, procainamide, flecainide, or amiodarone.Monitor patient on telemetry until 24hrs after symptomatic resolution.Vasopressors if hypotension is persistent.0.5 ounces (15mL) Syrup of Ipecac orally with 500mL of water.If in austere environment with limited resources and delayed extraction time:.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.Avoid in patients actively vomiting or with altered mental status.No prospective studies so recommendations are case dependent.Administration of activated charcoal (0.5-1.0 gm/kg up to 50g) within 1 hour.Hepatic and renal impairment are common.Acid-base disorder including respiratory acidosis, respiratory alkalosis, and metabolic acidosis common.Elevated CPK and troponin levels with or without myocardial infarction may occur.Digoxin or digitalis (Foxglove), which is similar in appearance to Aconitum.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.Accidental Ingestion vs suicide attempt.Respiratory muscle paralysis often necessitates intubation or leads to deathĭigitalis (Foxglove) is the natural predecessor of the cardiac glycoside digoxin which can also mimic aconitum toxicity.Cardiotoxic effects are often persistent and recurrent due to delayed clearance of toxic alkaloids.Ventricular tachycardia, bifascicular ventricular tachycardia, polymorphic ventricular tachycardia, torsades de pointes.Arrhythmias- most common cause of mortality, include:.May present with chest pain, palpitations, and syncope.Symptom onset typically between 3 minutes and 6 hours after ingestion with gradual progression of severity.Estimated lethal dose of wild plant is 1g.Most herbal preparations undergo decoction process where plant is boiled to hydrolize alkaloids.Bind to open voltage-gated sodium channels, producing a hyperpolarized state, with permanent activation of the channels.All parts of Aconitum are toxic, with the roots being most toxic.A recent increase in aconitum poisoning has been reported secondary to an increase in available herbal medications utilizing the plant.Traditionally, most cases of adult ingestion of toxic flowers that lead to significant symptoms are suicidal attempts.Most poisonous flower ingestions are accidental ingestions by children, which account for roughly 2% of all toxic exposures.In the US, it is not a commonly ingested flower, but is responsible for significant morbidity and mortality.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.A map of the distribution of Aconitum across the United States
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