Editing Aconitine (section)

==Diagnosis and treatment==
For the analysis of the ''Aconitum'' alkaloids in biological specimens such as blood, serum and urine, several [[GC-MS]] methods have been described. These employ a variety of extraction procedures followed by derivatisation to their trimethylsilyl derivatives. New sensitive [[Liquid chromatography–mass spectrometry|HPLC-MS]] methods have been developed as well, usually preceded by SPE purification of the sample.<ref name=Beike>{{cite journal | vauthors = Beike J, Frommherz L, Wood M, Brinkmann B, Köhler H | title = Determination of aconitine in body fluids by LC-MS-MS | journal = International Journal of Legal Medicine | volume = 118 | issue = 5 | pages = 289–93 | date = October 2004 | pmid = 15674996 | doi = 10.1007/s00414-004-0463-2 | s2cid = 2490984 }}</ref> The antiarrhythmic drug [[lidocaine]] has been reported to be an effective treatment of aconitine poisoning of a patient. Considering the fact that aconitine acts as an agonist of the [[sodium channel]] receptor, antiarrhythmic agents which block the sodium channel (Vaughan-Williams' classification I) might be the first choice for the therapy of aconitine induced arrhythmias.<ref>{{cite journal | vauthors = Tsukada K, Akizuki S, Matsuoka Y, Irimajiri S | title = [A case of aconitine poisoning accompanied by bidirectional ventricular tachycardia treated with lidocaine] | language = ja | journal = Kokyu to Junkan. Respiration & Circulation | volume = 40 | issue = 10 | pages = 1003–6 | date = October 1992 | pmid = 1439251 }}</ref> Animal experiments have shown that the mortality of aconitine is lowered by [[tetrodotoxin]]. The toxic effects of aconitine were attenuated by tetrodotoxin, probably due to their mutual antagonistic effect on excitable membranes.<ref>{{cite journal | vauthors = Ohno Y, Chiba S, Uchigasaki S, Uchima E, Nagamori H, Mizugaki M, Ohyama Y, Kimura K, Suzuki Y | title = The influence of tetrodotoxin on the toxic effects of aconitine in vivo | journal = The Tohoku Journal of Experimental Medicine | volume = 167 | issue = 2 | pages = 155–8 | date = June 1992 | pmid = 1475787 | doi = 10.1620/tjem.167.155 | url = http://www.jstage.jst.go.jp/article/tjem1920/167/2/167_2_155/_pdf | format = pdf | doi-access = free }}</ref> Also [[paeoniflorin]] seems to have a detoxifying effect on the acute toxicity of aconitine in test animals. This may result from alternations of pharmacokinetic behavior of aconitine in the animals due to the pharmacokinetic interaction between aconitine and paeoniflorin.<ref>{{cite journal | vauthors = Fan YF, Xie Y, Liu L, Ho HM, Wong YF, Liu ZQ, Zhou H | title = Paeoniflorin reduced acute toxicity of aconitine in rats is associated with the pharmacokinetic alteration of aconitine | journal = Journal of Ethnopharmacology | volume = 141 | issue = 2 | pages = 701–8 | date = June 2012 | pmid = 21930193 | doi = 10.1016/j.jep.2011.09.005 }}</ref> In addition, in emergencies, one can wash the stomach using either tannic acid or powdered charcoal. Heart stimulants such as strong coffee or caffeine may also help until professional help is available.<ref>{{cite book | first = Sax N. | last = Irving | name-list-style = vanc | title = Dangerous Properties of Industrial Materials | edition = Fifth | location = New York | publisher = Van Nostrand Reinhold Company Inc. | isbn = 978-0-442-27373-6 | lccn = 78-20812 | year = 1979 }}</ref>