Monkshood Poisoning: Symptoms, Signs, and What to Do

Aconite (monkshood, wolfsbane) contains aconitine, a potent neurotoxin/cardiotoxin that binds open voltage-gated Na⁺ channels → persistent depolarization.

Onset & Symptoms

Rapid (minutes to 2 hrs post-ingestion):

• Neurologic: Paresthesia (perioral, extremities) → numbness, weakness, ataxia, dysarthria, seizures, coma.
• Cardiovascular: Bradycardia, hypotension, ventricular arrhythmias (bidirectional VT, VF), AV block — leading cause of death.
• GI: Nausea, vomiting, diarrhea, abdominal pain.
• Respiratory: Dyspnea, respiratory depression/failure.

Management

• ABCs, cardiac monitoring, IV access.
• Decontamination: Activated charcoal (if <1 hr, protected airway).
• Arrhythmia treatment: Amiodarone (preferred), lidocaine. Avoid calcium channel blockers, β-blockers, digoxin (worsen). Cardioversion for unstable VT/VF.
• Hemodynamic support: Fluids, vasopressors (norepinephrine), atropine for bradycardia.
• No specific antidote.

Key Takeaway

Aconite poisoning causes life-threatening arrhythmias and neurotoxicity. Treatment is supportive with aggressive cardiac management; no antidote exists.