Jesaconitine monitoring in a case of severe aconitum poisoning with torsade de pointes treated via extracorporeal membrane oxygenation.

Aconitum poisoning is a serious condition that can lead to severe arrhythmias, which are irregular heartbeats that can be life-threatening. In a recent case study, a male patient in his 20s ingested aconite roots with the intention of taking his own life. The patient subsequently developed a severe form of arrhythmia known as refractory torsade de pointes (TdP), which required immediate medical attention. To stabilize the patient's condition, he was placed on veno-arterial extracorporeal membrane oxygenation, a treatment that helps to oxygenate the blood and support the heart. The patient's condition improved significantly over time, with his TdP resolving within 7 hours of arrival at the hospital and his heart returning to a normal sinus rhythm within 12 hours. He was discharged from the hospital 6 days later, having fully recovered. The case study also provided valuable insights into the levels of aconitine alkaloids in the patient's blood and urine over time. The results showed that jesaconitine, one of the four alkaloids measured, had the highest serum concentration. The patient's sinus rhythm returned when the jesaconitine concentration fell below 1 ng/mL. This correlation between jesaconitine levels and clinical symptoms suggests that monitoring these levels could be useful in guiding treatment decisions for patients with severe Aconitum poisoning. Overall, this study provides new information about the effects of Aconitum poisoning and the potential for using alkaloid levels to inform treatment.