There is no specific antidote for aconite poisoning. In a patient who develops marked sinus bradycardia and hypotension shortly after ingesting Aconitum-containing herbal decoction, the most appropriate drug for the bradyarrhythmia is:
- A Physostigmine
- B Atropine ✓
- C Adenosine
- D Amiodarone
Explanation
Management of aconite poisoning is supportive, with aggressive decontamination and cardiac monitoring. Atropine is the standard agent for the bradycardia and hypotension caused by vagal stimulation and aconitine's sodium-channel effects, with pacing reserved for refractory cases. Physostigmine is the cholinesterase inhibitor used in anticholinergic (datura) poisoning and would worsen bradycardia here. Adenosine treats re-entrant supraventricular tachycardia, and amiodarone addresses ventricular ectopy, neither of which addresses the predominant bradycardic picture.
Reference: Parikh's Textbook of Medical Jurisprudence and Toxicology, 8th ed.
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