Aconitine, a toxic alkaloid extracted from the aconite plant, poses significant challenges in clinical and forensic settings due to its potent cardiotoxic and neurotoxic effects. The improper use of aconitine can lead to severe and potentially fatal health complications, including ventricular arrhythmias and central nervous system disturbances. Diagnosing aconitine poisoning can be particularly difficult, especially in postmortem cases, as the substance is rapidly metabolized and autopsy findings are often non-specific. This difficulty in diagnosis highlights the need for a comprehensive understanding of aconitine's effects and the development of effective diagnostic approaches. A retrospective study of 35 reported cases of aconitine poisoning, published between 1958 and 2024, provides valuable insights into the clinical and forensic aspects of aconitine exposure. The analysis reveals that the cardiovascular and nervous systems are most commonly affected, with symptom severity varying widely among individuals, regardless of dosage. This suggests that there is a significant interindividual susceptibility to aconitine's toxic effects. The study also identifies the most common biological matrices for toxicological analysis, including blood, urine, liver, and kidney, as well as the utility of alternative samples such as hair and fecal matter in certain cases. Notably, the study finds that alcohol can potentiate the absorption and toxicity of aconitine, and that transdermal exposure can occur, particularly when applied to compromised skin. These findings emphasize the importance of timely toxicological testing and the use of alternative biological matrices in both clinical and forensic settings, ultimately contributing to improved diagnostic accuracy and supporting forensic determinations in cases of aconitine poisoning. The study's results have significant implications for the management and investigation of aconitine-related cases, highlighting the need for careful consideration of individual susceptibility, exposure routes, and the potential for enhanced toxicity due to factors such as alcohol consumption. Link: https://pubmed.ncbi.nlm.nih.gov/40315779/