An autopsy showed a dilatated heart with a transversal diameter of the left ventricle of around 65 mm, pulmonary edema, bilateral bronchopneumonia, liver and kidney necrosis, hypocellular bone marrow with diserythopoiesis, dismyeloiesis and dismegacaryopoiesis. Subsequent toxicology analysis by gas chromatography coupled to mass spectrometry showed colchicine in the patient gastric lavage, urine and serum samples, which were stored in light-protected containers (Table (Table1) 1). At the end of day 3 the patient went into asystolic cardiac arrest and cardiopulmonary resuscitation was unsuccessful. Profuse bleeding from the nose appeared and fresh frozen plasma and platelets were given. Laboratory tests also revealed rhabdomyolysis, coagulopathy and deterioration of metabolic acidosis, renal function and hepatic function (Table (Table1). Bilateral infiltrates appeared on the chest X-rays. Abdominal peristaltic sound could not be detected and abdominal X-ray showed a dilated intestine. On day 3 the patient developed a high-grade fever and became hypotensive and anuric despite hydration and noradrenaline infusion. The electrocardiogram showed only diffuse nonspecific ST changes, yet with positive troponin I values indicating myocardial necrosis (Table (Table1 1). The echocardiogram revealed heart dilatation with an ejection fraction of less than 30%. He developed acute respiratory failure, and assisted mechanical ventilation was started. We report accidental lethal Colchicum autumnale poisoning where blood colchicine levels were obtained.ĪST, aspartate aminotransferase ALT, alanine aminotransferase LDH, lactate dehydrogenase CK, creatine kinase. Searching Medline we found only four case reports of accidental poisoning with Colchicum autumnale, and in none of them were blood colchicine concentrations measured. Accidental poisoning with Colchicum autumnale is very rare. Colchicine is used in the management of acute gouty arthritis, and a suicidal colchicine tablet overdose is the most common cause of colchicine poisoning. Ĭolchicine has been responsible for numerous intoxications and deaths. Renal excretion is responsible for only about 20% of unchanged colchicine elimination, although this fraction may be increased in the presence of liver disease. There is significant biliary excretion and enterohepatic recirculation. When ingested, colchicine is rapidly absorbed from the gastrointestinal tract and is primarily metabolized by the liver in a first-order process. This second phase can last for 5–7 days and is followed by the third phase, characterized by leukocytosis and alopecia. During 24–72 hours, the second stage of intoxication, life-threatening complications occur such as heart failure, arrhythmias, renal failure, hepatic injury, respiratory distress, coagulopathies, bone marrow depression and neuromuscular involvement. The first phase is characterized by peripheral leukocytosis, gastrointestinal symptoms with fluid losses and hypovolemic shock. The clinical manifestations of colchicine poisoning are present in three phases following a latent period of 4–12 hours. On the third day the patient died due to asystolic cardiac arrest.Ĭolchicum autumnale, commonly known as the autumn crocus, wild saffron and naked lady, contains alkaloid colchicine that is antimitotic, blocking the mitosis by preventing DNA synthesis and tubulin polymerization. Therapy was supportive with hydration, vasopressors, mechanical ventilation and antibiotics. The toxicological analysis disclosed colchicine in the patient's urine (6 μg/l) and serum (9 μg/l) on the second day. Laboratory tests also revealed rhabdomyolysis, coagulopathy and deterioration of renal function and hepatic function. The respiratory insufficiency was further deteriorated by pneumonia, confirmed by chest X-ray and later on by autopsy. The echocardiogram showed heart dilatation with diffuse hypokinesia with positive troponin I. On the second day the patient became somnolent and developed respiratory insufficiency. On admission the patient had laboratory signs of dehydration. A 76-year-old man with a history of alcoholic liver disease and renal insufficiency, who mistakenly ingested Colchicum autumnale instead of wild garlic ( Aliium ursinum), presented with nausea, vomiting and diarrhea 12 hours after ingestion.
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