Department of Forensic Medicine and Judicial Appraisal Center, School of Basic Medicine and Biological Sciences, Suzhou Medicine College of Soochow University, Suzhou, China.
J Forensic Sci. 2024 Nov;69(6):2317-2324. doi: 10.1111/1556-4029.15621. Epub 2024 Sep 4.
Diester diterpenoid alkaloids (DDAs) are the main active ingredients of herbaceous perennial plants Aconitum. DDAs possess cardiotoxic and neurotoxic properties. Although most deaths caused by DDA poisoning are accidental, a few instances of suicide and homicide have been reported. Presented is a case of an acute aconitine (AC) poisoning following the ingestion of approximately 50 mL of homemade medicinal liquor. We described the clinical manifestations after poisoning and detailed postmortem changes, and detected the concentrations of AC and hypaconitine (HA) by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The decedent experienced a burning sensation in the gastrointestinal tract after poisoning, followed by flushing and paralysis of the face and limbs, and severe cardiac arrhythmia. An autopsy revealed cyanosis of the lips and nail beds; conjunctival hemorrhage in both eyes; pulmonary edema; tissue hemorrhage and congestion in multiple organs; and inflammatory cell infiltration in the stomach, duodenum, pancreas, and cardiac muscle. The concentrations of AC and HA were as follows: cardiac blood, 38.4 ng/mL and 7.1 ng/mL; pericardial fluid, 7.3 ng/mL and 41 ng/mL; urine, 28.1 ng/mL and 574 ng/mL; bile, 38.5 ng/mL and 108 ng/mL; gastric contents, 0.06 mg and 0.56 mg; liver tissue, 10.7 ng/g and 109.6 ng/g; and medicinal liquor, 0.568 mg/mL and 0.664 mg/mL, respectively. The clinical manifestations, anatomy findings, and quantitative data on the concentrations of AC and HA in body fluids and tissues will aid forensic investigations of deaths caused by acute AC poisoning.
二酯型二萜生物碱（DDAs）是多年生草本植物乌头属植物的主要活性成分。DDAs 具有心脏毒性和神经毒性。尽管大多数由 DDA 中毒引起的死亡是意外的，但也有一些自杀和他杀的报告。本文报道了一起因摄入约 50ml 自制药酒而导致急性乌头碱（AC）中毒的病例。我们描述了中毒后的临床表现和详细的死后变化，并通过液相色谱-串联质谱（LC-MS/MS）检测了 AC 和次乌头碱（HA）的浓度。中毒后，死者先出现胃肠道烧灼感，继而出现面部和四肢麻木、严重心律失常。尸检显示嘴唇和指甲床发绀；双眼结膜出血；肺水肿；多个器官组织出血和淤血；胃、十二指肠、胰腺和心肌有炎症细胞浸润。AC 和 HA 的浓度如下：心血，38.4ng/mL 和 7.1ng/mL；心包液，7.3ng/mL 和 41ng/mL；尿液，28.1ng/mL 和 574ng/mL；胆汁，38.5ng/mL 和 108ng/mL；胃内容物，0.06mg 和 0.56mg；肝组织，10.7ng/g 和 109.6ng/g；药酒，0.568mg/mL 和 0.664mg/mL。AC 和 HA 在体液和组织中的浓度的临床表现、解剖学发现和定量数据将有助于对急性 AC 中毒死亡进行法医调查。
