What to do for aconitine poisoning
Nov 25, 2025
Source: Cainiu Health
Dr. Wang Lei
Introduction
In general, emergency treatment for aconitine poisoning mainly includes immediate emesis or gastric lavage, oral administration of activated charcoal to adsorb the toxin, intravenous fluid replacement to promote excretion, lidocaine injection to correct arrhythmias, and blood purification to remove free toxins. If symptoms such as numbness of lips and tongue or ventricular premature beats occur, the patient should be immediately sent to the hospital. During the recovery phase, continuous electrocardiographic monitoring for 48 hours is recommended, and diet should start with lukewarm liquid foods.
Under normal circumstances, the emergency treatment methods for aconitine poisoning mainly include immediate emesis or gastric lavage, oral administration of activated charcoal to adsorb toxins, intravenous fluid replacement to promote excretion, lidocaine injection to correct arrhythmias, and blood purification to remove free toxins. If symptoms such as numbness of the lips and tongue or ventricular premature beats occur, the patient should be sent to the hospital immediately. Specific analysis is as follows:
1. Immediate emesis or gastric lavage
Aconitine stimulates sodium channel opening and delays myocardial repolarization. Residual drugs in the stomach can continue to be absorbed into the bloodstream. Gastric lavage with lukewarm water under low pressure within two hours of ingestion reduces toxin load and lowers peak cardiotoxicity.
2. Oral activated charcoal to adsorb toxins
The porous structure of activated charcoal can bind lipophilic diterpenoid alkaloids, interrupting enterohepatic circulation. Adults should take a single dose of 50 grams mixed into a suspension, followed by mannitol as a laxative to accelerate the elimination of bound toxins.
3. Intravenous fluid replacement to promote excretion
Large volumes of crystalloid fluids maintain urine output at over 200 mL per hour, diluting the concentration of free aconitine in plasma. Simultaneous supplementation of potassium and magnesium helps stabilize myocardial membrane potential and reduces the risk of ventricular fibrillation.
4. Lidocaine injection to correct arrhythmias
Lidocaine blocks fast sodium channels and shortens the action potential duration in damaged Purkinje fibers. It acts rapidly against polymorphic ventricular tachycardia. The initial dose is 1.5 mg/kg administered intravenously, with half-doses repeated if necessary.
5. Blood purification to remove free toxins
When blood drug concentrations are high and spontaneous cardiac rhythm is difficult to maintain, hemoperfusion combined with continuous venovenous hemofiltration can reduce plasma peak concentrations within two hours, alleviating refractory ventricular tachycardia.
During recovery, continuous electrocardiographic monitoring for 48 hours is recommended. Oral diet should initially consist of lukewarm liquids, avoiding spicy or stimulating foods that may trigger sympathetic excitation. Alcohol and strong tea should be avoided for one week to prevent myocardial irritability. If tingling in the fingertips recurs, an ECG should be promptly repeated; patients must not self-administer antiarrhythmic drugs.
