{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T15:43:21Z","timestamp":1781883801091,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute poisoning from toxic substances significantly endangers human health, with poisoning-induced cardiac arrest representing a critical public health concern. Xiaozhong Jiuwei Powder (XZJWP), a traditional Chinese medicine (TCM) formulation used in Mongolian Medicine, is known for its antipyretic, analgesic, and anti-inflammatory properties. However, improper use of XZJWP can lead to severe adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study, we report a fatal case of refractory ventricular fibrillation in a patient admitted to our hospital in autumn 2023, following the improper use of XZJWP. Despite intensive treatment, the patient succumbed to the condition 1 week later. To identify the toxic chemicals responsible for this outcome, a comprehensive chemical profiling of XZJWP was conducted using UPLC-Q-Orbitrap-HRMS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis identified 292 compounds, categorized into 24 major groups, with several toxic alkaloids detected. Notably, diester-diterpenoid alkaloids (DDAs), including aconitine, mesaconitine, and hypaconitine, were identified as key toxic compounds known to cause neurotoxicity and cardiotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings warrant caution in using XZJWP and other aconite-containing TCMs, emphasizing the need for public education on safe use and improved clinical management of related poisonings. The study provides crucial guidance for healthcare professionals in diagnosing and treating such toxicities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1682854","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T05:19:12Z","timestamp":1761542352000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A fatal intractable ventricular fibrillation triggered by improper use of Xiaozhong Jiuwei Powder: integrated LC-MS chemical profiling unveils the cardiotoxic culprits"],"prefix":"10.3389","volume":"12","author":[{"given":"Halidan","family":"Abudu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaofei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilidaer","family":"Sidike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqiong","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haojun","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayixiamuguli","family":"Wubuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.resuscitation.2006.06.040","article-title":"Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin","volume":"72","author":"Hess","year":"2007","journal-title":"Resuscitation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1016\/j.resuscitation.2010.08.006","article-title":"Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies","volume":"81","author":"Berdowski","year":"2010","journal-title":"Resuscitation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.resuscitation.2016.10.019","article-title":"Medical versus nonmedical etiology in out-of-hospital cardiac arrest\u2014changes in outcome in relation to the revised Utstein template","volume":"110","author":"Claesson","year":"2017","journal-title":"Resuscitation"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.resuscitation.2023.110012","article-title":"Out-of-hospital cardiac arrest caused by poisoning \u2013 a Swedish nationwide study over 15 years","author":"Lindqvist","year":"2023","journal-title":"Resuscitation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e060378","DOI":"10.1136\/bmjopen-2021-060378","article-title":"Nationwide population-based study of poisoning-induced out-of-hospital cardiac arrest in South Korea","volume":"12","author":"Park","year":"2022","journal-title":"BMJ Open"},{"key":"ref6","first-page":"71","article-title":"Research Progress of Mongolian medicine Xiaozhong Jiuwei powder","volume":"27","author":"Bao","year":"2021","journal-title":"J. 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