Veratrum poisonings are known to the toxicology literature as multiple Veratrum species grow in different parts of the Northern Hemisphere and are occasionally ingested by mistake. Veratrum toxicity is attributed to the steroidal alkaloids contained in all parts of the plant. In Russia Veratrum poisonings are more common since there is an over-the-counter Veratrum Lobelianum-based tincture, Veratrum Aqua (VA), that is topically used for treatment of lice infestation. Despite its toxicity, VA is misused in traditional medicine as a remedy for alcohol use disorder. We describe four cases of VA poisoning that occurred in Moscow, Russia. Three main Veratrum Lobelianum alkaloids (jervine, protoveratrine A and protoveratrine B), were determined in patient plasma and urine samples using liquid chromatography tandem mass-spectrometry (LC-MS/MS). Here we describe a novel validated LC-MS/MS method for jervine and protoveratrine A quantification. Simple and rapid liquid-liquid extraction with methyl tert-butyl ether was utilized for analyte extraction. Chromatographic separation was achieved using Poroshell 120 EC-C18 column, and the total run time was 14 min. The lower limit of quantification was 0.1 ng/mL for jervine and proA in both plasma and urine. Biological samples were obtained upon hospital admission and during treatment, thus enabling to get a better understanding of the alkaloid elimination profile. Upon admission plasma concentrations of jervine (concentration range: 0.10-5.01 ng/mL) prevailed over protoveratrine A (concentration range: 0-0.67 ng/mL). At this time, protoveratrine A already reached maximum concentrations in urine (concentration range: 0.15-37.70 ng/mL). Maximum concentrations of jervine in urine were observed 24 hours after admission (concentration range: 0.10-9.55 ng/mL). In all cases plasma concentrations of Veratrum alkaloids correlated with condition severity. Since none of the patients confirmed VA intake, instrumental analysis was the basis for the definitive diagnosis of VA poisoning.

中文翻译：

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四例藜芦水中毒中藜芦生物碱的测定。

在毒理学文献中，藜芦中毒是众所周知的，因为北半球的不同地区生长着多种藜芦，有时会被误食。藜芦的毒性归因于植物所有部分中所含的甾体生物碱。在俄罗斯，藜芦中毒更为常见，因为有一种非处方的以藜芦为基础的tin剂，藜芦水（VA），通常用于治疗虱子侵扰。尽管有毒性，但VA在传统医学中仍被误用作酒精滥用障碍的药物。我们描述了在俄罗斯莫斯科发生的四起VA中毒案例。使用液相色谱串联质谱法（LC-MS / MS）在患者血浆和尿液样品中确定了三种主要的藜芦生物碱（牛,、原藜芦碱A和原藜芦碱B）。在这里，我们描述了一种新的经过验证的LC-MS / MS方法，用于水母和Protoveratrine A的定量分析。采用甲基叔丁基醚进行简单，快速的液-液萃取可进行分析物的萃取。使用Poroshell 120 EC-C18色谱柱进行色谱分离，总运行时间为14分钟。血浆和尿液中牛j和proA的定量下限为0.1 ng / mL。入院时和治疗过程中均获得了生物样品，因此可以更好地了解生物碱的消除特征。入院时，绞股蓝的血浆浓度（浓度范围：0.10-5.01 ng / mL）高于原胃泌素A（浓度范围：0-0.67 ng / mL）。此时，原胰高血糖素原A在尿液中已达到最大浓度（浓度范围：0.15-37.70 ng / mL）。入院后24小时观察到尿液中水母的最大浓度（浓度范围：0.10-9.55 ng / mL）。在所有情况下，藜芦生物碱的血浆浓度均与病情严重程度相关。由于没有患者确认VA摄入，因此仪器分析是确定VA中毒的基础。