Fatal aconite poisoning in a rural Nepali traditional healer: clinical challenges and management strategies.

Introduction And Importance: Aconite, also known as Aconitum spp., is a group of highly toxic flowering plants used historically in traditional medicine despite their potent neurotoxic and cardiotoxic effects. In rural Nepal, where traditional healing practices are prevalent, accidental ingestion of Aconite remains a significant public health concern due to its resemblance to medicinal herbs.

Case Presentation: The authors present a case of severe Aconite poisoning in a 45-year-old male traditional healer from rural Nepal. Following ingestion of a homemade herbal tea containing Aconitum species, the patient developed rapid-onset symptoms, including paresthesia around the mouth, severe abdominal pain, and progressive weakness. Upon admission, he exhibited signs of cardiovascular compromise and metabolic acidosis. Despite aggressive management, including gastric lavage, fluid resuscitation, and symptomatic treatment, the patient succumbed to cardiovascular collapse within 12 h of admission.

Clinical Discussion: Aconite poisoning manifests with early neurological symptoms and progresses to severe gastrointestinal and cardiovascular complications. Its toxicity is attributed to aconitine, which disrupts cellular function by binding to voltage-gated sodium channels. Management focuses on supportive care and symptomatic treatment, given the absence of a specific antidote and challenges in rural healthcare settings.

Conclusion: This case underscores the critical need for awareness among healthcare providers and the public regarding the dangers of Aconite. Improved education, healthcare infrastructure, and early intervention are essential in mitigating the morbidity and mortality associated with Aconite poisoning in resource-limited settings.