A case of fatal aconitine poisoning by Monkshood ingestion

Accidental aconitine poisoning is extremely rare in North America. This report describes the confirmation of a case of accidental aconitine poisoning using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. The case involved a 25-year-old man who died suddenly following a recreational outing with friends where he consumed a number of wild berries and plants including one that was later identified as Monkshood (Aconitum napellus). Postmortem blood and urine samples were available for analysis. All routine urine and blood toxicology screens were negative. The LC-MS/MS method allowed sensitive quantification of aconitine, the main toxin in A. napellus, and showed 3.6 and 149 microg/L in blood and urine, respectively. These concentrations were similar to that reported in other aconitine-related deaths. This case illustrates the dangers of consuming unidentified plants, and documents concentrations of aconitine in blood and urine in a fatal case of A. napallus-related poisoning.     

A case of fatal poisoning with the aconite plant: quantitative analysis in biological fluid.

In recent years recorded cases of plant poisoning have become rare, this may in part be due to the possibility of plant ingestion not being indicated at the beginning of an investigation. Aconitum napellus (aconite, Wolfsbane, Monkshood) is one of the most poisonous plants in the UK. It contains various potent alkaloids such as aconitine, isoaconitine, lycaconitine and napelline. Ingestion of Aconitum plant extracts can result in severe, potentially fatal toxic effects. This paper describes the analytical findings in a recent death in the UK. resulting from deliberate ingestion of Aconitum napellus extract. The concentrations of aconitine measured by HPLC-DAD in the post mortem femoral blood and urine were 10.8 micrograms/L and 264 micrograms/L, respectively. The aconitine concentration in the ante mortem urine was 334 micrograms/L and was estimated to be 6 micrograms/L in the ante mortem serum. Hence, accidental, suicidal or homicidal poisoning due to the ingestion of plant material remains a possibility and should be borne in mind when investigating sudden or unexplained death.     

生物检材中乌头碱的LC-MS/MS快速分析

目的应用高效液相色谱-质谱法对生物检材中乌头生物碱等有毒成分进行快速分析。方法取全血样品经乙腈-甲醇(5:1 v/v)提取,使用Agilent Zorbax SB C18(2.1 mm×50 mm,1.8μm)色谱柱,以0.1%甲酸溶液-乙腈(60:40 v/v)为流动相等度洗脱。在多反应监测模式下测定全血样品中乌头生物碱等有毒成分。结果乌头碱、次乌头碱和中乌头碱的保留时间为0.73 min、0.77 min和0.63 min;用于定量分析的离子对分别为m/z 646.4→586.4(乌头碱)、616.1→556.5(次乌头碱)和632.4→572.1(中乌头碱)。乌头碱在0.1~250 ng/m L内线性关系良好,相关系数(r)≥0.9987,最低检出限0.1ng/m L,精密度考查其变异系数(CV)5.42%(n=6),血液中乌头碱提取回收率不小于90%。结论本文建立的高效液相色谱-质谱法快速、简便、灵敏,适用于天然药毒物检验。     

高效液相色谱法快速分离测定血浆中的乌头碱

目的建立血液中乌头碱的高效液相色谱快速分析方法。方法以空白人血浆添加乌头碱标准品对血液样品的前处理方法、仪器测试条件、线性范围、精密度、回收率进行全面考查,建立乌头碱定量分析方法。对血液中所含乌头碱的浓度进行测定。结果该方法在血液中的线性范围是0.1~5.0μg/m l;最低检测浓度为0.1μg/m l;日内、日间精密度分别小于3.7%和4.5%;回收率在(97.0±4.1)%以上。结论所建方法实用、便捷,可对血液中乌头碱的含量进行快速测定。     

高效液相色谱法分离测定药酒中乌头碱的含量

目的建立药酒中乌头碱的高效液相色谱快速分析方法。方法以白酒添加乌头碱对照品对药酒样品的前处理方法、仪器测试条件、线性范围、精密度、回收率进行全面考察,建立定量分析方法。对药酒中所含乌头碱的浓度进行测定。结果该方法乌头碱在药酒中的线性范围是0.45～9.0μg·mL-1;日内、日间精密度分别小于3.1%和4.7%;回收率在(97.3±2.8)%以上。结论所建方法实用、便捷,可对药酒中乌头碱的含量进行快速检测。     

乌头碱对培养新生大鼠心室肌细胞Connexin43蛋白磷酸化的影响

目的建立细胞水平的染毒模型,观察乌头碱对心肌细胞缝隙连接蛋白Connexin43(Cx43)的影响。方法实验分0.25、0.5、0.75、1.0、1.5和2.0μmol/L等6个不同浓度乌头碱染毒组,运用蛋白印迹法和免疫荧光技术,检测各组及对照组心肌细胞Cx43蛋白磷酸化状态的改变。结果蛋白印迹检测显示,不同浓度染毒组心肌细胞中Cx43蛋白总量与正常对照组无显著差异;0.5μmol/L乌头碱染毒后,Cx43开始出现脱磷酸化;当染毒浓度达到1.0μmol/L后,Cx43脱磷酸化显著,且1.5及2.0μmol/L染毒效果和1.0μmol/L染毒组相当。免疫荧光分析结果提示乌头碱作用后,心肌细胞Cx43蛋白在羧基端第368位点丝氨酸残基(Ser368)发生明显的脱磷酸化。结论一定浓度的乌头碱能诱导心肌细胞缝隙连接蛋白Cx43发生显著脱磷酸化。     

乌头碱对新生大鼠心肌细胞DNA损伤的影响

目的探讨乌头碱对新生大鼠心肌细胞DNA损伤的影响。方法新生SD大鼠20只,随机分为4组,取心室肌以差速贴壁法原代培养心室肌细胞。培养第6天,制成密度为2×105个细胞/mL的细胞悬液,分别加入乌头碱混合液至终浓度为0.1、0.5、1、2μmol/L,染毒30m in;采用彗星电泳技术及CASP分析软件,检测不同浓度乌头碱染毒后心室肌细胞DNA损伤程度。结果心肌细胞被不同浓度乌头碱染毒后,尾部DNA含量、彗尾长度、尾矩、O live尾矩均随乌头碱浓度增加而升高,头部DNA含量则逐渐降低,与对照组相比,有显著性差异(P<0.01);乌头碱染毒剂量越大,心肌细胞DNA损伤越严重。结论乌头碱染毒引起细胞DNA断裂损伤呈明显的剂量—效应关系,推测细胞DNA损伤是乌头碱毒作用机制之一。     

短柄乌头急性中毒——乌头碱在大鼠体内分布的研究

本文用高效液相色谱法检测了大白鼠短柄乌头急性中毒后(LD_(50)剂量灌胃),乌头碱在心、肝、肾、血、脑内的含量分布。结果表明;体内乌头碱含量甚微或检不出。30例大鼠LD_(50)剂量灌胃后,16例2h内中毒死亡。其肝、肾内的乌头碱检出率明显高于心、血、脑,且中毒表现明显。另14例于2h整处死,其肝、肾、血中检出较高。16例2h内死亡组肝中乌头碱含量分析提示乌头碱在体内代谢很快。此结果为法医工作中乌头碱中毒案件调查、检材提取、毒物分析结果的评价提供了一定的依据。     

乌头类生物碱对心肌的毒性作用及分子毒理学研究进展

乌头属植物是被子植物亚门毛茛科中一类重要的有毒植物,也是我国最早有记载的药用有毒植物之一;其块根中多含有剧毒的二萜类双酯型生物碱?乌头碱,因个体差异、用法不当以及误服或投毒等原因而发生乌头中毒、甚至死亡的报道屡见不鲜。目前,对乌头碱的研究多局限在临床救治方面,缺乏对乌头碱毒性作用机制研究。本文参考国内外相关文献资料,对乌头碱的心肌细胞毒性作用机制进行了综述。     

液相色谱质谱联用测定乌头碱在大鼠体内代谢产物

目的鉴定乌头碱在大鼠体内的主要代谢产物。方法灌胃给予雄性大鼠1.0mg/kg乌头碱后,收集24h尿液,固相萃取法提取,液相色谱-质谱法测定乌头碱及其代谢物。结果经与空白组对照发现给药后大鼠尿样中除乌头碱原体外还有4种代谢产物,并分别测得其准分子离子峰及其各级碎片离子。结论经与对照品比较及质谱断裂规律推断4个代谢产物分别为中乌头碱、16-O-去甲基乌头碱、16-O-去甲基中乌头碱、苯甲酰乌头碱。     

生物检材中乌头碱的GC/MS分析

目的 建立GC/MS-SIM检测生物检材中乌头碱的定性方法。方法 以MSTFA作为衍生化试剂,吡啶为溶剂,于60℃反应30min,综合质谱图及保留时间定性分析。结果 经该方法测得乌头碱最小检出量为20ng(S/N≥100)。结论 GC/MS-SIM法适用于药材及生物检材中乌头碱的定性分析。     

Aconitum alkaloid content and the high toxicity of aconite tincture

Although proprietary medicines and decoction of processed aconite roots are the most widely used, tincture accounts for the great majority of aconite poisoning cases in China, indicating that it is much more toxic than other formulations. Aconite tincture is often self-prepared at home and raw aconite plants or roots are often used. Even if processed aconite roots were used to make the tincture, the amount of Aconitum alkaloids is highly variable, depending on the adequacy of processing and quality control. Aconitum alkaloids dissolve efficiently in alcohol. For these reasons, tincture contains very high concentrations of Aconitum alkaloids. Despite its high intrinsic toxicity, overdose of aconite tincture by the users has been common. Severe aconite poisoning can be complicated by fatal ventricular tachyarrhythmias and asystole. The public should be repeatedly warned of the danger of taking aconite tincture by mouth.     

乌头中剧毒生物碱的提取分离

目的从乌头属植物中提取分离剧毒生物碱乌头碱、中乌头碱、次乌头碱;方法酸性水溶液提取,碱化后中性氧化铝柱层析,IR、EI-MS确认结构;结果利用该方法提取以上3种生物碱得到的回收率与碱性苯溶液法相似。结论该方法所用试剂成本低、毒性小,适用于制备乌头碱、中乌头碱、次乌头碱对照品。     

乌头中剧毒生物碱的提取分离（Ⅱ）

目的从短距牛扁中提取分离含C14 茴香酰基剧毒二萜生物碱。方法采用 95 %乙醇提取 ,酸性水溶液溶解醇提物 ,脱脂并碱化后经硅胶柱层析及制备薄层分离 ,以UV、HPLC MS、13CNMR方法确证结构。结果利用该方法可对短距牛扁中黄草乌碱丙、粗茎乌碱甲、滇乌碱进行有效提取。结论本研究提示对乌头属植物中毒案件进行检验时仅以乌头碱类生物碱 (C14 苯甲酰基 )作为监测成分是不够的 ,还应注意检材中是否含有滇乌碱型生物碱成分。     

甲基苯丙胺和乙醇在染毒大鼠体内联用的实验研究

目的研究甲基苯丙胺（MA）和乙醇联合应用在急性、亚急性染毒大鼠体内的情况。方法以MA1.0 mg/kg剂量对慢性自由饮酒大鼠多次腹腔注射,分别建立急性、亚急性染毒大鼠模型;处死后即时检测血中乙醇浓度、体液和组织样品中MA的浓度。结果多次注入MA药后,亚急性中毒大鼠体内的MA浓度高于急性中毒大鼠;急性和亚急性联合中毒大鼠体内MA浓度均高于急性和亚急性单一药物组。结论无论是否联用乙醇,14d内增加注射次数会在大鼠体内产生不同程度的MA残留;与乙醇联用可加速MA在大鼠体内的吸收,其药物浓度的升高程度随生物样品不同存在差异。     

Seven cases of fatal aconite poisoning: forensic experience in China

This paper presents seven fatal cases of aconite poisoning encountered in the Tongji Center for Medicolegal Expertise in Hubei (TCMEH), China, from 1999 to 2008 retrospectively. In six of the cases, deaths occurred after drinking homemade medicated liquor containing aconite, and in one case death was due to ingestion of traditional Chinese medication containing aconite. Forensic autopsy and pathological examinations ruled out the presence of physical trauma or life-threatening diseases. Diagnosis of aconite poisoning was made after postmortem toxicological analysis. Animal experiment was performed in one case demonstrating that the medicated liquor could cause death rapidly. We present the autopsy and histopathological findings, toxicological analysis, and results of animal experiment done on samples from those seven cases. As an important herbal Chinese medicine, Aconitum species deserve special attention, especially because it contains poisonous alkaloids.     

Review of factors susceptible of influencing post-mortem carbohydrate-deficient transferrin

Seric carbohydrate-deficient transferrin (CDT) is a biochemical marker of chronic alcohol abuse. Assessment of the influence of factors likely to modify CDT concentration is necessary to justify its use in the analysis of post-mortem blood samples. Hemolysis, site of collection and storage were tested. Hemolysed samples showed decreased CDT concentration. Statistical analysis of CDT concentration in cardiac blood versus femoral blood revealed no significant differences. Storage for fifteen days at +4 degrees C or +20 degrees C did not affect CDT concentration but repeated freezing and thawing resulted in decreased levels of CDT.     

Acute arsenic poisoning: clinical, toxicological, histopathological, and forensic features

This report describes a suicide case by acute arsenic intoxication via intravenous injection. A 30-year-old woman injected arsenic As (V) (sodium arseniate disodique: Disodium Hydrogena Arsenik RP) in a successful suicide attempt. Three hours following administration, the woman developed severe digestive symptoms. She was admitted to a hospital and transferred to the intensive care unit within 12 h of the massive administration of arsenic. Despite therapeutic efforts, over the next 2 h she developed multiorgan failure and died. A postmortem examination was performed. Pulmonary edema and congestion of liver were apparent. As (V) and As (III) were determined by high performance liquid chromatography and inductively coupled plasma mass spectrometry after mineralization of samples by concentrated nitric acid. Toxicological analysis revealed high concentrations of arsenic in biological fluids as well as in organs. Histopathological examination showed a typical indication of myocarditis. These findings were in agreement with acute arsenic poisoning. The symptoms developed by this young woman (intoxication by intravenous administration) were comparable to oral intoxication. The clinical signs, survival time, and administration type are discussed in light of the literature on acute and chronic arsenic poisoning.     

Morphine and 6-acetylmorphine concentrations in blood, brain, spinal cord, bone marrow and bone after lethal acute or chronic diacetylmorphine administration to mice

The aim of this study was to evaluate postmortem incorporation of opiates in bone and bone marrow after diacetylmorphine (heroin) administration to mice. Mice were given acute (lethal dose of 300 mg/kg) or chronic (10 and 20 mg/kg/24 h for 20 days) intraperitoneal administration of diacetylmorphine. The two metabolites of diacetylmorphine, 6-acetylmorphine (6-AM) and morphine, were extracted from whole blood, brain, spinal cord, bone marrow and bone (after hydrolysis) using a liquid/liquid method. Quantification was performed by gas chromatography-mass spectrometry (GC/MS). Results showed that after acute administration, opiates were present in all studied tissues. Morphine concentrations appeared to be higher than those of 6-AM in blood (52.4 microg/mL versus 27.7 microg/mL, n=12), bone marrow (87.8 ng/mg versus 8.9 ng/mg, n=6) and bone (0.85 ng/mg versus 0.43 ng/mg, n=6), but 6-AM concentrations were higher than those of morphine in brain (14.0 ng/mg versus 7.4 ng/mg, n=12) and spinal cord (27.8 ng/mg versus 20.8 ng/mg, n=12). No correlation was found for both compounds between blood concentrations and either brain, spinal cord, bone or bone marrow concentrations while a significant one was found between brain and spinal cord concentrations either for morphine (r=0.89, n=12, p<0.001) or 6-AM (r=0.93, n=12, p<0.001), the concentration being higher in spinal cord than in brain. When bones were stored for 2 months, only 6-AM remained in bone marrow but not in bone. After chronic administration, mice being sacrificed by cervical dislocation 24 h after the last injection, no opiate was detected in any studied tissues. Further studies are required, in particular in human bones, but these results seem to show that 6-AM could be detect in bone marrow several weeks after the death and could be an alternative tissue for forensic toxicologist to detect a fatal diacetylmorphine overdose, even if no correlation between blood and bone marrow was observed. On the other hand, neither bone tissue nor bone marrow will allow the confirmation of a chronic diacetylmorphine use.     

氯硝安定在急性中毒家兔体内的分布

从生物检材中提取、分离氯硝安定，采用薄层色谱扫描法能准确地定性、定量，对急性中毒家兔体内氧硝安定测定结果表明，当血浓度达峰时，尿和胆汁中的含量显著高于其它脏器中的含量，说明肾、胆是氯硝安定的主要排泄途径。在疑为氯硝安定中毒时，采集尿、胆汁行毒物分析是必要的。