AconitumAlkaloidPoisoning.pptVIP

Aconitum Alkaloid Poisoning Review of Cases Aconitum L. (烏頭) 製川烏 毛茛科植物烏頭的母根的炮製品 1.5~3g 製草烏 毛茛科植物北烏頭的塊根的炮製品 1.5~3g 製附子 毛茛科植物烏頭的子根的炮製品 3~15g 草烏 Wide variety in China market Source: Cultivated /Wild 16 species Aconitum alkaloids Aconitine (乌头碱), Hypaconitine (次乌头碱), Mesaconitine (新乌头碱) Effective ingredients Analgesic and anti-inflammatory actions Potent toxins Cardio-toxic, neuro-toxic voltage-gated Na(+) channel activators Processing (炮製) Essential to reduce toxicity As low as 0.3g of 生草烏 is toxic Hydrolysis: Aconitine? Benzoylaconine ?Aconine 1/200 Toxic 1/2000 Toxic 生薑、甘草: decrease aconite toxicity ? pH of herbal broth ? enhance hydrolysis 十八反: 本草明言十八反,半蔞貝薟芨攻烏, 藻戟遂芫俱戰草,諸參辛芍叛藜蘆. 烏頭反半夏: enhance aconite toxicity ? pH of herbal broth ? inhibit hydrolysis Aconitum Poisoning Taiwan 17 cases from 1990-99 H.K. PWH (1989-91): 15 patients DH (1/00 – 6/04): 7 admissions with 3 requiring intensive care All recovered Overdose /improper decoction/ self-prescription Case 1 Apr 2004 M/20 Taking TCM for back pain for 2 months Formula did not contain aconite herbs 牛膝, 杜仲,杞子, 知母, 川斷, 白芥子, 蒼朮, 白朮, 防風, 淫羊藿, 百花蛇, 枳殼, 白芍, 威靈仙, 茯苓, 狗脊, 春砂仁 Bought 3 identical packs of herbs from herbal shop Became unwell shortly after taking second pack Vomiting Drowsy ECG: polymorphic ventricular tachycardia Arrhythmia resistant to treatment Admitted to Cardiac care unit Recovered eventually Lab Findings Herbal broth remains: Aconitum alkaloids (yunaconitine, crassicauline) detected by LCMS Suggestive of 云南烏頭 No herbal residue for inspection 3rd pack of raw herbs: No aconite herbs on inspection No aconitum alkaloids detected by chemical analysis Urine: Aconitum alkaloids detected + drugs given after admission Cause of Poisoning: Aconite contamination Present in the 2nd pack but not the 1st /3rd pack Case 2 June 2004 F/50 Inoperable kidney tumor On TCM for pain control and tolerated Double dosage by herself 熟附子(五錢), 製川烏(六錢), 製草烏(六錢) 生薑、甘草 二錢 Presented with