Aconite is one of the most poisonous known herbs. It has been known to be used as a homicidal poison from long time in history. However this is rarely known to be used as suicidal poison. Poisoning with aconite is usually fatal and death commonly occurs due to arrhythmias and cardiotoxicity. We report a case of attempted suicidal poisoning by aconite where patient survived in spite of documented cardiotoxic effects of the poison

Prashar, A

Satish, Kumar

Sharma, A

Sharma, M

English

Mohit Sharma

Satish Kumar

Aditi Prashar

Ashok Sharma

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An interesting case of suicidal poisoning

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Case Report:
An interesting case of suicidal poisoning
Mohit Sharma Junior Resident,
Satish Kumar, Senior Resident,
Aditi Prashar, Intern,
Ashok Sharma, Professor
Dept. of Medicine, Indira Gandhi Medical College, Shimla - 17001 (Himachal Pradesh)
Address For Correspondence:
Dr. Mohit Sharma,
H. No - 2082/3,
Sector - 45-C, Chandigarh - 160047. 
E-mail: docmohitsharma@gmail.com
Citation:  Sharma M, Satish Kumar, Prashar A, Sharma A. An interesting case of suicidal poisoning.  Online J Health Allied Scs.  
2009;8(4):14
URL: http://www.ojhas.org/issue32/2009-4-14.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Mar 22, 2009; Suggested revision: Apr 14, 2009; Resubmitted: July 8, 2009; Accepted: Jul 10, 2009; Published: Apr 30, 2010
Abstract:
Aconite is one of the most poisonous known herbs. It has been 
known to be used as a homicidal poison from long time in his-
tory. However this is rarely known to be used as suicidal pois-
on.  Poisoning  with  aconite  is  usually  fatal  and  death  com-
monly occurs due to arrhythmias and cardiotoxicity. We report 
a case of attempted suicidal poisoning by aconite where pa-
tient survived in spite of documented cardiotoxic effects of the 
poison.
Key Words: Suicidal poisoning, aconite, mohra
Introduction:
Aconite  tubers  are  most  toxic  wild  plants  distributed  from 
Asia to western Europe.1-4 It Was notorious in the 19th century 
as an agent for homicides and suicides. Aconite was believed 
by the Greeks to be the first  poison created by the goddess 
Hecate from foam of the river Cerebrus.5 Before the birth of 
Christ it was known as ‘queen mother of all poisons. Aconite 
was  also  known  to  Hindu  medicine  as  recorded  in  Vedas 
around 900 BC.6 The Lepchas of sikkim have a saying that 
Aconite  is  ‘useful  to  hunters  for  destroying  elephants  and 
tigers, useful to the rich for putting troublesome relatives out 
of  the  way and useful  for  jealous  husbands  for  destroying 
faithless wives’. The Lepchas are believed to have poisoned 
the water supply of British troops with powdered aconite in 
the expedition of 1887.5 Indian Aconite root or Nepal Aconite 
consists of the root of  A. laciniatum. It is also called Bikh or 
Bish,  and is collected in Nepal.  It  is  a  conical root,  2 to 4 
inches long and an inch or more at the top, of a light brown 
color. Other varieties of Aconite are A. chasmanthum, known 
in  India  as  Mohri  and Mohra,  which contains  Indaconitine. 
Aconite is common in the Himalayas. In the state of Himachal 
Pradesh  it  occurs  sporadically  in  many  areas.  In  traditional 
medicine aconite is used externally in mustard oil for massage 
in  neuralgia,  paralysis  and  rheumatism.  Root  is  used  in 
diseases  such  as  Leprosy  and  Cholera,  and  as  a  tonic  in 
diarrhea and cough.7 Aconite has been used as Chinese herbal 
medicine,  which  are  freely purchased from herb  shops  and 
used as decoction by herbal practitioner for pain control.8 In 
Japan, some cases of aconite poisoning appeared as result of 
committing  suicide  or  accidental  ingestion,  mistaken  for 
edible  grass.  However  aconite  alkaloids  have  potential  of 
serious  and  even  fatal  cardiotoxity,  which  is  difficult  to 
manage.  It  has still  remained difficult  to save these patients 
with  therapeutic  resistant  fatal  arrhythmias.9,10 We  are 
reporting  a  case  of  suicidal  poisoning  with  a  herb  locally 
known as mohri or mohra, the local name for aconite.11
Case Reports:
A 30 years  old  female patient  was referred from a primary 
health  centre  with  diagnosis  of  unknown  herbal  poisoning. 
The name of the alleged poison was mentioned as ‘mohra’ in 
the medicolegal case report attached with the referral slip. Pa-
tient’s  attendants  told  that  when  patient’s  husband  retuned 
home from work in the evening she was anxious and had two 
episodes of vomiting. Her seven year old son told that the pa-
tient had consumed a herb known as ‘mohra’. Patient’s attend-
ants knew this herb to be a very poisonous herb which grew in 
the forest near the village and caused fatal poisoning. Attend-
ants had this knowledge from local hearsay and also reported 
that this  herb was available with  local quacks and religious 
healers and was used in preparing medicines.
On further questioning they described the herb found with the 
patients as dry woody roots. Patient was asymptomatic apart 
from having restlessness and feeling of suffocation and naus-
ea. Physical examination was unremarkable apart from occa-
sional  irregular beats in pulse and the patient was hemody-
namically  stable.  Electrocardiogram  showed  presence  of 
ventricular ectopics.(Fig-1)
The treating doctors did not know about the herb but based on 
the  description  of  the  herb  and presence  of  ectopics  in  the 
ECG possibility of aconite poisoning was kept and patient was 
shifted to cardiac care unit for continuous ECG and hemody-
anamic monitoring. Patient’s attendants were shown pictures 
of aconite plant and roots and recognized these as those con-
sumed by the patient. Patient was managed conservatively and 
improved. ECG changes reverted to normal after one day (Fig-
2). Patient subsequently remained asymptomatic and was dis-
charged after five days.
1
This work is licensed under a Creative 
Commons Attribution-No Derivative Works 
2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 8, Issue 4; Oct - Dec 2009
Figure 1
Figure 2
2
Discussion:
Aconite was used throughout Europe as a wolf poison, and in 
India as a tiger poison, lacing meat left for the man-eaters to 
scavenge. Several of its common names allude to this value: 
Wolfsbane, Leopard Bane, Tiger Bane, Dog's Bane, & occa-
sionally,  a  mite  absurdly,  Wolf's  Hat.  It  was  even  called 
Mousebane, because of the belief that its odour could kill  a 
mouse at a great distance. Aconite root contains from 0.3 to 1 
per cent alkaloidal  matter,  consisting of Aconitine  - crystal-
line, acrid and highly toxic - with the alkaloids Benzaconine 
(Picraconitine) and Aconine.12 Aconitine is the only crystalliz-
able alkaloid in it and amounts to less than 0.2 percent. The 
Aconitines are a group of highly toxic alkaloids derived from 
various species of Aconite. They are chemically distinguish-
able according to  the source from which they are obtained. 
The Aconitines are divided into two groups: (1) the Aconitines 
proper,  including  Aconitine,  Japaconitine  and  Indaconitine, 
and (2) the Pseudaconitines - Pseudaconitine and Bikhaconit-
ine. 
The  symptons  of  poisoning  are  tingling  and  numbness  of 
tongue and mouth and a sensation of ants crawling over the 
body,  nausea  and  vomiting  with  epigastric  pain,  difficult 
breathing,  irregular and weak pulse,  cold and clammy skin, 
giddiness with preserved sensorium.12 Aconite alkaloids have 
potential of serious and even fatal cardiotoxity, which is diffi-
cult to manage. It has still remained difficult to save these pa-
tients with therapeutic resistant fatal arrhythmias.9,10 Mechan-
istically, aconitine increases sodium influx through the sodium 
channel, increasing inotropy while delaying the final repolar-
ization phase of the action potential and promoting premature 
excitation Sinus bradycardia and ventricular dysrhythmias can 
occur. Symptoms can occur from 5 minutes to 4 hours after in-
gestion.5
This  patient  had typical  symptoms  of  aconite  poisoning  in-
cluding nausea, vomiting, epigastric discomfort and weak, ir-
regular pulse. Patient was in hypotension and had ventricular 
ectopics in her ECG. The patient improved with conservative 
management and didn’t develop other arrhythmias. This relat-
ively  benign  course  may  be  because  poison  consumed  had 
probably been processed for medicinal use. Though aconite is 
considered to be an ideal homicidal poison for many reasons, 
it has also been used for suicide at many occasions. But not all 
deaths  have  been  intentional  homicides  or  suicides,  for 
Monkshood is sometimes mistaken for fennel or horseradish 
or  other  edible plant,  as even the  species  name  napellus  or 
"Little  Turnip"  alludes  to  its  resemblance  to  something  ed-
ible.12 Aconite chasanthamum is the most commonly used spe-
cies among the poisonous species of aconite.  It is used in a 
number  of  medicines after  mitigation/detoxification.  Detoxi-
fication usually involves soaking aconite roots in cows urine 
for  several  weeks  or  prolonged  boiling  for  as  long  as  48 
hours.11 According to an article by the Indian scientists Thorat 
and  Dahanukar,  "Crude  aconite  is  an  extremely  lethal  sub-
stance. However, the science of Ayurveda looks upon aconite 
as a therapeutic entity. Crude aconite is always processed i.e. 
it undergoes 'samskaras' before being utilized in the Ayurvedic 
formulations. This study was undertaken in mice, to ascertain 
whether 'processed' aconite is  less  toxic  as compared to the 
crude or unprocessed one. It was seen that crude aconite was 
significantly toxic to mice (100%) mortality at a dose of 2.6 
mg/mouse) whereas the fully processed aconite was absolutely 
non-toxic (no mortality at a dose even 8 times as high as that 
of  crude aconite).  Further,  it  says  “all  the  steps in the pro-
cessing were essential for complete detoxification”.13 This pa-
tient had consumed aconite in the form of a dry root which is 
some times kept by faith healers and quacks for medicinal pur-
poses. She took it with the intention of committing suicide but 
survived, may be because the dried roots of aconite kept for 
medicinal use are usually processed by various methods men-
tioned above. This case was unique because despite of being 
touted as an ideal homicidal  poison  aconite is very uncom-
monly implicated or  even suspected in  poisonings.  Survival 
after aconite ingestion is even less common.  Even more in-
triguing is the fact that given the relatively easy availability, 
ease of administration, simulation of natural illness by symp-
toms and difficulties in isolating poison from viscera.5 It still 
remains a rare cause of poisoning deaths. Or is it that it is not 
just suspected to be!
References:
1. Geoffrey  French.  Aconitine-Induced  Cardiac  Ar-
rhythmia. Br. Heart J 1958;20: 140-142
2. Tai YT, But PP, Young K, Lau CP. Cardiotoxity 
After Accidental Herb-Induced Aconite Poisoning. 
Lancet 1992;340:1254-1256
3. Chan TY. Aconitine Poisoning: A Global Perspect-
ive. Vet Hum Toxicolo 1994;36:326-328
4. 4. Chan TY, Tomlinson B, Tse LK, Chan JC, Chan 
WW,  Critchley JA.  Aconitine  Poisoning  Due To 
Chinese  Herbal  Medicines:  A  Review.  Vet  Hum 
Toxicolo 1994;36:452-455
5. Vij K. Textbook of Forensic Medicine and Toxico-
logy: Principles and Practice. 3rd edition. Reed El-
sevier India Private Ltd. India. 2005:647-750.
6. Das RK. Epidemiology of insecticide poisoning at 
AIIMS emergency services and role of its detection 
by gas  liquid  chromatography  in  diagnosis.  Med 
Leg Update 2007;7:49-60.
7. Chauhan NS. Medicinal and Aromatic Plants of In-
dia. Indus Publishing. 1999. pp 65-69.
8. Fatovich  DM.  Aconite:  A  Lethal  Chinese  Herb. 
Ann Emerg Med 1992;21:309-311
9. Kolev ST, Leman P, Kite GC, Stevenson PC, Shaw 
D, Murray VS. Toxicity Following Accidental In-
gestion of Acotinum Containing Chinese Remedy. 
Hum Exp Toxicol 1996;15:839-842
10. Honerjager P, Meissner A. The Positive Inotropic 
Effect of Aconitine.  Naunyn Schmiedebergs Arch 
Pharmacol 1983;322:49-58
11. Shah NC. Conservation aspects of  Aconitum  spe-
cies in the Himalayas with special reference to Ut-
taranchal (India). Newsletter of the Medicinal Plant 
Specialist  Group  of  the  IUCN  Species  Survival 
Commission 2005; vol 11: 9-15.
12. Grieve M. Aconite. A modern herbal. Available at 
http://www.botanical.com
13. Thorat  S,  Dahanukar  S.  Can  We  Dispense  With 
Ayurvedic  Samskaras? J  Postgrad  Med. Jul 
1991;37(3):157-9.
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Aconitine-Induced Cardiac Arrhythmia.

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An interesting case of suicidal poisoning

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