A Rare Case of Aconite Poisoning in a Tertiary Care Center in Nepal: Clinical Presentation and Management

Introduction: Aconite poisoning, caused by the toxin aconitine in the Aconitum genus (monkshood or wolfsbane), can be severe and requires supportive care as there is no specific antidote. Aconitine inhibits sodium channel inactivation, leading to dangerous cardiovascular and neurological symptoms.  Case Presentation: A 46-year-old male ingested half of a suspected aconite seed, leading to abdominal cramping, persistent vomiting, tingling sensations, and weakness. Upon admission, he exhibited hypotension, tachycardia, and bilateral mydriasis. ECG showed ventricular premature contractions. Treatment included intravenous amiodarone, magnesium sulfate, calcium gluconate, and gastric lavage with activated charcoal. He was admitted to the ICU for intensive monitoring and treatment, including ongoing amiodarone administration. After improvement, he was transferred to the general ward and later discharged.  Discussion: Aconite poisoning involves symptoms from aconitine's effect on sodium channels, including arrhythmias, hypotension, and neurological issues. Management focuses on supportive care, antiemetics, and monitoring. Advanced treatments like flecainide or amiodarone may restore normal heart rhythm, and severe cases might require a cardiac bypass or VA- ECMO.  Conclusion: This case describes a rare aconite poisoning with severe neurological, cardiovascular, and gastrointestinal symptoms after ingestion of a suspected aconite seed. The patient was treated with decontamination, intravenous amiodarone, and ICU care, leading to recovery. Despite its traditional use, aconite poisoning often results from its application without proper regulation, highlighting the need for rapid diagnosis and management.