FATAL ACCIDENTAL ACONITINE POISONING FOLLOWING INGESTION OF CHINESE HERBAL MEDICINE - A REPORT OF 2 CASES

Two Hong Kong Chinese adults were prescribed aconitine-containing herb al preparations by Chinese herbal practitioners for relief of minor mu sculoskeletal pain. After ingestion both quickly developed ventricular tachycardia followed by ventricular fibrillation and cardiac arrest r efractory to resuscitation; death in both cases occurred within 12 h o f ingestion. Neither had a history of cardiac disease. Coroners' autop sies showed no significant macroscopic or microscopic findings, with n o evidence of ischaemic heart disease or other cardiac disease. Toxico logical examination of stomach contents showed a trace of hydrolysed a conitine in one case but was negative in the other. Analysis of the he rbal preparations consumed, however, confirmed the presence of the aco nitine-containing herbs in quantities greatly in excess of the maximum recommended in the P.R. China pharmacopoeia. Both patients therefore consumed an accidental overdose of aconitine, which has a narrow safet y margin between therapeutic analgesic effect and its known cardiotoxi c effect. These particular herbal medicines are controlled substances in mainland China and Taiwan, but no controls on their dispensing exis t in Hong Kong. Together with reported non-fatal cases of aconitine po isoning, these cases emphasise that legal controls of the dispensing a nd use of aconitine-containing herbal preparations are necessary in Ho ng Kong.