Accidental intoxication with Veratrum album.
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.
Grobosch
T
T
Berliner Betrieb für Zentrale Gesundheitliche Aufgaben (BBGes), Institute of Toxicology and Poison Information Centre Berlin, Oranienburger Str. 285, 13437 Berlin, Germany. grobosch.tox@bbges.de
Binscheck
T
T
Martens
F
F
Lampe
D
D
D000059:Accidents; D000434:Alcoholic Beverages / Q000032:analysis / Q000506:poisoning; D000931:Antidotes / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002606:Charcoal / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D002855:Chromatography, Thin Layer; D030012:Gentiana; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007202:Indicators and Reagents; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D021241:Spectrometry, Mass, Electrospray Ionization; D013056:Spectrophotometry, Ultraviolet; D014703:Veratrum / Q000737:chemistry* / Q000506:poisoning*; D014704:Veratrum Alkaloids / Q000032:analysis* / Q000506:poisoning*
D000931:Antidotes; D000932:Antiemetics; D007202:Indicators and Reagents; D014704:Veratrum Alkaloids; D002606:Charcoal