Toxic Flowers and Aconite Poisoning: A Case of Critical Illness after Chinese Herbal Tea

Background: Aconite is a highly toxic alkaloid found in flowering plants used in traditional Asian medicine to treat pains, bruises, and other ailments. Also known monkshood or wolfsbane, the substance can cause... [ view full abstract ]

Background: Aconite is a highly toxic alkaloid found in flowering plants used in traditional Asian medicine to treat pains, bruises, and other ailments. Also known monkshood or wolfsbane, the substance can cause life-threatening cardiac and neurological toxicity by binding and maintaining sodium channels in the open position. 

Case description: We present an otherwise healthy 36 year old male who presented with acute life-threatening aconite poisoning one hour after ingesting a Chinese herbal tea for upper respiratory symptoms. The patient collapsed upon presentation to the emergency department, developing seizure-like activity and found to be in unstable ventricular tachycardia. After initial resuscitation, antiarrhythmic, and anticonvulsant treatment, the patient was admitted to the critical care unit intubated for continued management. Toxicological analysis confirmed aconite in tea samples brought in by the patient's family and the department of public health was informed. The patient continued to improve in the critical care unit and was discharged in stable condition two days later

Discussion: A review of the literature accompanies this rare but significant intoxication. Aconite has a well-documented association with life-threatening ventricular dysrhythmias and neurological symptoms such as weakness and paresthesias. A narrow therapeutic index and lack of an antitode have been implicated in its toxicity. As the popularity of herbal medicine increases, examples such as this case highlight that such herbal remedies are not without potential harm.