| Background and purpose:Aconitine is an extremely toxic alkaloid.Its therapeutic dosage is close to the amount that causes toxicity.Chuanwu is one of Acontitum species and its main poisonous ingredient is aconite alkaloids.Aconite poisoning can occur after an adult ingests 3-90 grams of Chuanwu.After people ingest chuanwu accidentally or incorrectly multiple organs suffer from damage.The cardiotoxicity is particularly pronounced,which produces a variety of arrhythmias.If malignant arrhythmias are not dealt with promptly death easily ensues.Aconitine can severely damage myocardial cell membranes due to its actions on abnormal opening the ion channels.Besides as mentioned above,aconitine can also harm myocardial cells by induing abnormal cell excitability and conduction,which results in serious arrhythmias,such as ventricular tachycardia and ventricular fibrillation.Many ion channels will be affected by the toxicity of aconitine,especially the Na+ channel.The arrhythmogenic properties of aconitine is mainly related to the Na+ channel on the myocardial cell membrane.When a large number of Na+ channels are activated,sodium ions influx happens.This phenomenon accelerates the dipolarization rate of myocardial cell membrane.In addition,sympathetic nerve can be activated by aconitine.Sympathetic nerve releases a large amount of catecholamine,which leads to a tachycardia.Aconitine can also affect the vagus nerve in the way of increasing the nerve's excitability and releasing a large quantity of acetylcholine.The excitability of sinoatrial node and atrioventricular node is inhibited by acetylcholine,leading to severe bradycardia.The toxicity of aconitine also interferes with energy metabolism of myocardial cells to decrease the regeneration of ATP—the fuel of the active operation of intracellular ion.Accordingly,active transport function is reduced and electrolyte imbalance happens.Based on what have discussed above prompt removing those toxins from the body is the key treatment.Blood purification can eliminate the toxins completely.Aconitine alkaloid is one of diesters and it has a strong lipophilicity.Therefore,blood perfusion can easily eliminate these toxins.If this method is utilised in the early stage of the poisoning the effect will be more obvious.The combination of aconitine and proteins in blood can form relatively large molecular weight substances.It is easy to be adsorbed and removed by resin adsorbent in blood perfusion.The use of resin perfusion device has a higher success rate if it is used in the early stage.Unfortunately the toxins absorbed by the body can cause physiological damages and these damages can not be reversed by blood perfusion.However,hemofiltration can reverse these effects on brain tissues,myocardium and other organs.Those absorbed poisonous chemicals need to go through liver for clearance.From this point of view,hemofiltration can reduce the toxicity and lighten the liver's burden.In summary,hemoperfusion can effectively remove free-flowing toxins but has no effect on the pathophysiological damages caused by the absorbed toxins.On the other hand,hemofiltration works better on those adverse pathophysiological changes because it can remove excessive water and filter out creatinine,urea and other toxic substances.Those proactive actions lighten the metabolic burden of the liver and kidney,protect brain tissues and prevent heart failure.All these provide a favourable opportunity for subsequent rehydration and nutritional support.When aconitine poisoning occurs blood purification is the primary treatment.Mode selection of blood perfusion combined with hemofiltration can achieve a better result and a good prognosis can be expected.Method:In this paper,we retrospectively analyzed the experience of one case of cardiac event caused by aconitine poisoning in our hospital in January 22,2016,so that we can have a further understanding of the recognition and treatment of aconitine poisoning.The 40 years old male patient consumed 100 g Chuanwu at home.Consequently he suffered from serious malignant arrhythmias and multiple organ damages.Blood purification was utilised after limited effect of high-dose of Amidarone and Lidocaine,electrical cardioversion and defibrillation.Hemoperfusion combined with hemofiltration converted patient's heart beat to sinus rhythm and maintained it.Patient's damaged organs recovered without any complications.Conclusion:Speaking of the treatment of aconitine poisoning,if the conventional methods,like gastric lavage and catharsis,are not effective hemoperfusion combined with hemofiltration should be considered.They reduce the effect of free radical and inflammatory cytokines on cells and blood vessels and effectively correct malignant arrhythmia.The organ's function is protected and the progress is promising. |
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