A 17-year old man had roots of “toricabuto”, one of wild plant known as monkshood, which contains aconite alkaloids to commit suicide. Two hours later he begun nausea, vomiting and chest discomfort, and then he was transferred to hospital. At that time, ventricular tachycardia and ventricular fibrillation appeared with a rapid faint pulse, weak respiration, and loss of consciousness. Four and a half hours later, he was transported to our hospital by ambulance car. On admission, he was cardiac arrest and apnea so that he was immediately performed cardiopulmonary resuscitation (cpr, intubation and mechanical ventilation). After resuscitation, twelve-lead electrocardiogram showed multifocal tachycardia, torsade de pointes with rapid degeneration of ventricular fibrillation. Portable chest x-ray revealed no abnormality and laboratory examination revealed slight elevation of liver enzymes. Na, k and cl were 141.0, 4.6 and 106 meq/l respectively. Though intravenous infusion of several types of antiarrhythmics, such as lidocaine, mexiletine, magnesium, procaine and over thirty times of cardioversion had no effect of termination of such arrhythmia, forty minutes later from his admission he was performed percutaneous cardiopulmonary support system to maintain cerebral and visceral circulation.

Hypothermic therapy of 32 degree of rectal temperature was also performed to prevent brain damage and organ function, and then he was transferred to cardiac care unit for intensive care. He was maintained at least 60mmhg of systolic blood pressure and 50ml/hour of urination. Five hours later from the application, he improved decreased appearance of ventricular fibrillation. Fifteen hours later, sinus rhythm was appeared and he recovered from shock. About 48hours later, pcps was terminated with no difficulty. According to measurements of aconite alkaloids in blood and urine by gas chromatography selected ion monitoring ⁸,₉,₁₀, maximum aconitine concentration in blood was over 0.2ng/ml at nine hours later from his ingestion. It took eighteen hours that aconitine concentration in blood decreased below 0.12ng/ml (fig 1, which is fetal concentration of aconitine calculated from ld_{50 11}). He discharged, nineteen days following admission without any neurological deficit.

Figure 1

Fig 1: Changes Of Concentration Of Aconites In Blood.

A 41-year old male ate “torikabuto” aconite tuber mistaken for edible grass. Soon after eating it, he developed symptoms of numbness, nausea, vomiting and dysarthria and admitted to emergency room. He developed ventricular tachycardia and torsade de pointes with rapid degeneration of ventricular fibrillation. Portable chest x-ray was normal and laboratory examination revealed no abnormality. On admission, he was not unconsciousness but difficult to walk alone. Two hours later, frequent ventricular premature contractile appeared. Thirty hours later, ventricular tachycardia and ventricular fibrillation appeared and he was unconsciousness. He became cardiac arrest and apnea so that he was immediately performed cardiopulmonary resuscitation (cpr, intubation and mechanical ventilation). After resuscitation, it was difficult to maintain systemic circulation, so that percutaneous cardiopulmonary support was applied immediately. Primary flow rate of pcps was set as 3l/min, but it found very difficult to maintain systemic circulation, because of thin in and out catheters. Over forty times of direct current cardioversion were performed for fatal arrhythmia. Twenty-three hours later, we decided to apply cardiopulmonary bypass using canulations to ascending aorta and right atrium. Cardiopulmonary bypass was performed for 186 hours because of prolonged pulmonary edema and left ventricular dysfunction. He also had complicated pulmonary fibrosis and acute renal failure during his admission. Therefore he discharged, ninety-five days following admission with no neurological deficit.