Mass aconite poisoning from a mislabelled spice product

INTRODUCTION: (aconite). Most cases of poisoning involve the improper processing of traditional Chinese medicine. We report a mass poisoning event caused by consumption of unprocessed aconite root powders mislabeled as sand ginger. METHODS: We conducted a retrospective case series of patients who presented to two hospitals in the Greater Toronto area with aconite poisoning from a chicken dish eaten at a local restaurant. Demographic, management, and outcome data were collected by review of the electronic medical record. RESULTS: Over an 8 h period, 11 patients presented to hospital with features of aconite poisoning. Symptoms began shortly after ingestion and included perioral paraesthesia (91%) and nausea, vomiting and abdominal pain (64%). In the hospital, the spectrum of illness varied from paraesthesia requiring no intervention (9%) to refractory ventricular dysrhythmias (73%) managed with infusions of sodium bicarbonate, amiodarone, and vasopressors. Two patients received mechanical ventilation for 48 h. No patients died. A public health investigation identified a mislabelled sand ginger spice product imported from China as the source of unprocessed aconite (aconitine 0.55%). DISCUSSION: With the increasing availability of internationally sourced spice products, such events are likely to recur. CONCLUSIONS: This series demonstrates the potential for mass aconite poisoning through contaminated food and highlights the critical role of poison centers and public health systems in responding to such events.