Kohara S, Kamijo Y, Kyan R, Okada I, Hasegawa E, Yamada S, Imai K, Kaizaki-Mitsumoto A, Numazawa S. Severe aconite poisoning successfully treated with veno-arterial extracorporeal membrane oxygenation: A case report. World J Clin Cases 2024; 12(2): 399-404 [PMID: 38313648 DOI: 10.12998/wjcc.v12.i2.399]
Corresponding Author of This Article
Saeko Kohara, MD, Doctor, Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 1900014, Japan. kohara0611tdmc@yahoo.co.jp
Research Domain of This Article
Toxicology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Saeko Kohara, Ichiro Okada, Eiju Hasegawa, Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo 1900014, Japan
Saeko Kohara, Yoshito Kamijo, Ryoko Kyan, Department of Clinical Toxicology, Saitama Medical University, Saitama 3500495, Japan
Soichiro Yamada, Koichi Imai, Saitama Prefectural Institute of Public Health, Saitama Prefectural Institute of Public Health, Saitama 3550133, Japan
Asuka Kaizaki-Mitsumoto, Satoshi Numazawa, Division of Toxicology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, Tokyo 1428555, Japan
Author contributions: All authors contributed to the conception and design of the study; material preparation, data collection, and analysis were performed by Kamijo Y, Kyan R, Okada I, Hasegawa E, Yamada S, Imai K, Kaizaki-Mitsumoto A, and Numazawa S; the first draft of the manuscript was written by Kohara S; and all authors commented on previous versions of the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Saeko Kohara, MD, Doctor, Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 1900014, Japan. kohara0611tdmc@yahoo.co.jp
Received: September 28, 2023 Peer-review started: September 28, 2023 First decision: October 9, 2023 Revised: October 21, 2023 Accepted: December 25, 2023 Article in press: December 25, 2023 Published online: January 16, 2024 Processing time: 104 Days and 23.6 Hours
Abstract
BACKGROUND
Most species of aconite contain highly toxic aconitines, the oral ingestion of which can be fatal, primarily because they cause ventricular arrhythmias. We describe a case of severe aconite poisoning that was successfully treated through veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS).
CASE SUMMARY
A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled, “Aconitum japonicum Thunb”. Two hours after arrival, VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors. Nine hours after arrival, an electrocardiogram revealed a return to sinus rhythm. The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5, respectively. On hospital day 15, he was transferred to a psychiatric hospital. The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS, revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root. Serum on admission contained 1.50 ng/mL of aconitine. Beyond hospital day 2, neither were detected. Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine, but these rapidly decreased after hospital day 3.
CONCLUSION
The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.
Core Tip: Most species of aconite contain highly toxic aconitines, the oral ingestion of which can be fatal, primarily because they cause ventricular arrhythmias. The key to saving the lives of patients with severe aconite poisoning is to introduce veno-arterial extracorporeal membrane oxygenation as soon as possible when circulatory collapse becomes refractory to conventional treatments and to maintain it until the toxins are fully excreted from the body.
