Sodium Channel–Mediated Ventricular Arrhythmia After Delphinium denudatum Ingestion Managed Conservatively in a Resource-Limited Setting

BACKGROUND: Delphinium denudatum (jadwār) is a traditional South Asian herbal root containing aconitine-like alkaloids that cause sodium channel-mediated cardiotoxicity. Human toxicity data remain limited, particularly from resource-limited settings. CASE SUMMARY: A man in his late 20s presented 6 hours after accidental ingestion of Ddenudatum root with palpitations and autonomic symptoms. Continuous electrocardiographic monitoring revealed frequent ventricular ectopy with nonsustained polymorphic ventricular tachycardia. He was treated with intravenous lidocaine and magnesium sulfate, resulting in rapid suppression of ventricular arrhythmias. Lidocaine infusion was continued for 24 hours given uncertain toxin pharmacokinetics, followed by extended telemetry observation. DISCUSSION: This case demonstrates mechanism-based antiarrhythmic therapy for aconitine-like poisoning and highlights the importance of prolonged monitoring given the risk of delayed malignant arrhythmias. TAKE-HOME MESSAGE: Early sodium-channel blockade with lidocaine and structured cardiac monitoring can be lifesaving in plant-based cardiotoxicity.