Veratrum poisonings are described in 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), which is topically used for the 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 V. lobelianum alkaloids (jervine, protoveratrine A (proA) 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 proA quantification. A simple and rapid liquid–liquid extraction with methyl tert-butyl ether was utilized for analyte extraction. Chromatographic separation was achieved using a 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 proA (concentration range: 0–0.67 ng/mL). At this time, proA already reached maximum concentrations in urine (concentration range: 0.15–37.70 ng/mL). Maximum concentrations of jervine in urine were observed 24 h 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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四例藜芦水中毒的藜芦生物碱测定

藜芦中毒在毒理学文献中被描述为多种藜芦物种生长在北半球的不同地区，并且偶尔会被误食。藜芦的毒性归因于植物所有部位所含的甾体生物碱。在俄罗斯，藜芦中毒更为常见，因为有一种非处方的藜芦基酊剂 Veratrum Aqua (VA)，局部用于治疗虱子感染。尽管它有毒性，但 VA 在传统医学中被滥用作为治疗酒精使用障碍的药物。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 (LC-MS-MS) 在患者血浆和尿液样品中测定三种主要的半边莲生物碱 (jervine、原藜芦碱 A (proA) 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 jervine 和 proA 量化。使用甲基叔丁基醚进行简单快速的液-液萃取进行分析物萃取。使用 Poroshell 120 EC-C18 色谱柱实现色谱分离，总运行时间为 14 分钟。血浆和尿液中 jervine 和 proA 的定量下限为 0.1 ng/mL。在入院时和治疗期间获得生物样本，从而能够更好地了解生物碱的消除情况。入院时，jervine 的血浆浓度（浓度范围：0.10–5.01 ng/mL）优于 proA（浓度范围：0–0.67 ng/mL）。此时，proA 在尿液中的浓度已经达到最大值（浓度范围：0.15–37.70 ng/mL）。入院后 24 小时观察到尿液中 jervine 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与病情严重程度相关。由于没有患者证实摄入了 VA，因此仪器分析是明确诊断 VA 中毒的基础。