Forensic and toxicological insights into aconite poisoning: A retrospective analysis of clinical and postmortem findings

Abstract

Aconitine, a highly toxic alkaloid derived from the aconite plant, presents significant clinical and forensic challenges due to its cardiotoxic and neurotoxic effects. It may induce fatal ventricular arrhythmias and severe central nervous system disturbances when improperly used. The diagnosis of aconitine poisoning remains difficult, particularly in postmortem contexts, owing to its rapid metabolism and the non-specific nature of autopsy findings. In this retrospective study, we analyzed 35 reported cases of aconitine poisoning published between 1958 and 2024. Each case was evaluated for demographic characteristics, exposure route, clinical manifestations, treatment approaches, autopsy findings, and toxicological results. Our analysis revealed that the cardiovascular and nervous systems were most commonly affected, with symptom severity varying independently of dosage, suggesting interindividual susceptibility. Blood, urine, liver, and kidney represent the most common biological matrices for toxicological analysis. Hair analysis provides valuable chronological data in chronic exposure assessments, while fecal samples serve as reliable alternatives for postmortem detection when conventional specimens are unavailable or compromised. Notably, alcohol potentiates both the absorption and toxicity of aconitine. Furthermore, transdermal aconitine poisoning has been documented in fatal cases, particularly when applied to compromised skin integrity. These findings highlight the importance of timely toxicological testing and the utility of alternative biological matrices in both clinical and forensic settings, offering important insights for improving diagnostic accuracy and supporting forensic determinations in cases of aconitine poisoning.