with two case studies

2. Acontine is a diterpenoid alkaloid produced by
plants of the Aconitum genus.
Various species of Aconitum have been used
by different populations for centuries as
poisons and medicines, with certain species
still being used in Chinese and Japanese
herbal medicines.

4. At around 5 pm, he complained of nausea and
abdominal pain, vomited one half hour later, and
collapsed suddenly at 6:15 pm. Resuscitation was
attempted but was unsuccessful.
At autopsy, the nail beds were noted to be cyanosed.
Internal examination showed severe congestion of all
organs. Histologic examination revealed bilateral
massive intrapulmonary hemorrhage and edema. Urine
and blood were collected at the time of autopsy and
were sent for toxicological analyses.

5. Urine screens for drugs of abuse including screens for
cannabinoids, opiates, benzodiazepines, phencyclidine,
barbiturates, amphetamines, and cocaine metabolites were
negative. Analysis of the blood sample for both alcohol and
digoxin was negative.
The case history indicated the ingestion of A. napellus and the
possibility of aconitine poisoning.
A liquid chromatography tandem-mass spectrometry
(LCMS⁄MS) method was, therefore, developed for the
analysis of aconitine in the blood and urine samples.
These analyses confirmed the presence of aconitine which was
in the postmortem femoral blood sample at a concentration of
3.6 lg⁄L and in the urine sample at a concentration of 149
lg⁄L. The cause of death was considered to be aconitinie
poisoning secondary to ingestion of A. napellus.

6. For many thousands of years the toxicological properties
of particular plants have been exploited for both medicinal
and sometimes criminal purposes.
However, most cases of poisoning typically involve
pharmaceuticals or drugs of abuse and routine toxicological
analyses do not generally detect plant alkaloids.
Therefore, in recent years recorded cases of plant
poisoning have become a rare occurrence and instances may
be missed unless sufficient case history or scene evidence
is available.

7. Aconitum napellus (also known as aconite, Wolfsbane, Monkshood, etc) is
native throughout Europe. It is a perennial plant and can grow up to 1
metre high with light green leaves and blue, mauve or white flowers.
Although now seldom found wild, it is thought to be one of the most
poisonous plants in the United Kingdom and is still cultivated in domestic
gardens.
It is also related to the other Aconitum plants of the Ranunculaceae
family that are widely distributed across North America and northern
Asia.
Various Aconitum species are also used in Chinese herbal products mainly
for the treatment of musculoskeletal disorders, however, several cases of
poisoning have been reported.

8. A 60 year old male with personal problems
had produced an aconite extract for oral
ingestion by liquidising tissue from Aconitum
napellus (possibly self-cultivated).
Shortly afterwards he became agitated,
nauseous and began to vomit violently. An
ambulance was called and he was taken to a
nearby hospital

9. He remained conscious for a while and informed the staff
of the ingestion of aconite and his intentions. He was
treated supportively but died following cardio-respiratory
arrest, approximately two hours after ingestion.
A post-mortem examination one day after death revealed
no evidence of natural disease. Various plant tissues and
books pertaining to plant pathology/toxicology were found
at the original scene. Specimens of blood/serum and urine
obtained at post mortem and taken upon admission (ante
mortem), along with a sample of the apparent aconite
extract (liquid), were submitted for toxicological analysis.

11. A review by Chan of aconitine poisoning between 1955 and
1994 showed a total of 30 reported deaths, with 23
occurring in China.
However, there are very little published data regarding
aconitine concentrations measured in biological fluid. Two
recent papers presented extensive data for many Japanese
Aconitum plant alkaloids.
In these non-fatal and fatal cases, although jesaconitine was
determined to be the main alkaloid present, aconitine was
also detected and concentrations of 1.7 ygI1 and 1.1 ygll
were measured in the ante mortem serum and post mortem
blood, respectively. I
n both instances poisoning was attributed to aconite ingestion.
In the case presented here there was overwhelming clinical
and circumstantial evidence of Aconitum napellus
intoxication.

12. As this aconite species has a different alkaloid profile to that ingested in the
Japanese cases, it was not appropriate to compare aconitine concentrations.
Nevertheless, based on published information, the concentrations measured
(particularly in the post mortem femoral blood; 10.8 ygn) supported aconite
poisoning leading to cardiorespiratory arrest as the cause of death.
The additional presence of ethanol (166 mgldl) may have also exacerbated
toxicity. Plant alkaloids are not usually identified during routine toxicology
screening. However, as in this case, at high concentrations aconitine may be
detectable during routine screening for chemically basic drugs, particularly
when using HPLC-DAD or GC-MS.
Due to the vast numbers of possible alkaloids, difficulty in obtaining pure
analytical standards andthe lack of comparative cases it is difficult to
compile and maintain relevant data.
The only indication for potential plant poisoning will therefore probably be
based upon evidence at the scene or witness statements. Provision of material
in such cases is therefore vital in order to determine the relevant
toxicological analyses required.