Accidental Intoxication With Veratrum Album

J Anal Toxicol. Nov-Dec 2008;32(9):768-73. doi: 10.1093/jat/32.9.768.

Abstract

A 49-year-old man consumed two glasses (approximately 2 x 20 mL) of a beverage containing yellow gentian (Gentiana lutea). Shortly after ingestion, he developed nausea, vomiting, and oral paraesthesia. On admission to the hospital he suffered from severe bradycardia (35 beats/min) and hypotension (50/30 mm Hg), and he was treated with activated charcoal, antiemetics (metoclopramide, ondansetron), atropine, and intravenous electrolytic solution. The initial suspicion of Veratrum poisoning could be confirmed by identifying protoveratrines A (ProA) and protoveratrine B (ProB) in a sample from the beverage as well as in the patients serum by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS). The yellow-colored beverage contained 25% ethanol (by headspace gas chromatography), 20.4 mg/L ProA, and 13.7 mg/L ProB. The serum concentration of ProA was 1162 ng/L and ProB was 402 ng/L. Veratridine, cevadine, and jervine were not detected, neither in the beverage nor in the serum sample. The lower limits of quantitation for all compounds is 10 microg/L (S/N > 10, beverage) and 100 ng/L (S/N > 10, serum). After treatment, the patient completely recovered from the symptoms within 24 h and was discharged from the hospital. The analytical method described was developed for the simultaneous identification and quantitation of five Veratrum alkaloids. The method is based on a liquid-liquid extraction followed by LC-MS-MS analysis. The time needed for analysis was 6 min.

Publication types

  • Case Reports

MeSH terms

  • Accidents
  • Alcoholic Beverages / analysis
  • Alcoholic Beverages / poisoning
  • Antidotes / therapeutic use
  • Antiemetics / therapeutic use
  • Charcoal / therapeutic use
  • Chromatography, High Pressure Liquid
  • Chromatography, Thin Layer
  • Gentiana
  • Hemodynamics / drug effects
  • Humans
  • Indicators and Reagents
  • Male
  • Mass Spectrometry
  • Middle Aged
  • Spectrometry, Mass, Electrospray Ionization
  • Spectrophotometry, Ultraviolet
  • Veratrum / chemistry*
  • Veratrum / poisoning*
  • Veratrum Alkaloids / analysis*
  • Veratrum Alkaloids / poisoning*

Substances

  • Antidotes
  • Antiemetics
  • Indicators and Reagents
  • Veratrum Alkaloids
  • Charcoal