Combined blood purification and antiarrhythmic therapy for acute aconitine poisoning with refractory arrhythmias: a case-based mechanistic evaluation and treatment strategy optimization.

Introduction: Aconitine poisoning from traditional Chinese medicine is life-threatening, associated with arrhythmias and shock. Early diagnosis and multidisciplinary treatment are essential due to the lack of specific antidotes. This study aimed to present a severe case of aconitine poisoning and to evaluate the effectiveness of combined blood purification and antiarrhythmic therapy, thereby providing practical insights for clinical management. A 70-year-old man presented with coma, recurrent ventricular arrhythmias, and severe hypotension (nadir: 44/24 mmHg) after ingesting Fuzhi (Aconitum taipeicum). Toxicology confirmed high aconitine levels. He was treated with norepinephrine (0.17-0.33 μg/kg/min), intravenous amiodarone (150 mg bolus over 10-15 min, then 1 mg/min infusion), electrical cardioversion, and early blood purification (hemoperfusion + CVVH). He regained hemodynamic stability within 24 h and fully recovered at 6 months (LVEF 59-63%).

Conclusions: Combined antiarrhythmic therapy and blood purification proved effective. Early recognition and integrated care are key to managing aconitine poisoning.