Colchicine, an old and well-known
drug, is an
alkaloid extracted from Colchicum autumnale and related species.
Colchicine inhibits the deposition of
uric acid crystals and is an inhibitor of mitosis.
Nausea,
vomiting,
abdominal pain, and
diarrhea, with a massive loss of fluid and
electrolytes are the first clinical symptoms of
colchicine poisoning. Stomach lavage and rapid gastric decontamination with
activated charcoal are crucial. An acute dose of about 0.8 mg/kg of
colchicine is presumed to be fatal. We report the clinical outcomes of two different cases of
colchicine intoxication for attempted suicide. The dose required for morbidity or mortality varies significantly. The dose of 1 mg/kg in the first case was directly related with mortality, while the dose of 0.2 mg/kg in the second was related with survival. The other difference between the patients was the time of arrival to hospital after ingestion. This period was 4 hours for case 1 and only 1, hour for case 2. The initiation of treatment later than 2 hours after ingestion of
colchicine may significantly impair treatment because the absorption time for
colchicine after
oral administration is about 30-120 minutes. The rising
lactate level and high anion gap
metabolic acidosis in our patient (case 1) were attributed to
lactic acidosis, so
hemodialysis was performed, and the duration of
hemodialysis was prolonged.
Lactic acidosis in the first case was one of the reasons for mortality. The most important parameters which define the chance of survival are the dose of ingested drugs and the arrival time to hospital after ingestion. The patients must be monitored closely for
lactic acidosis and the decision to start
hemodialysis must be made promptly for patients who develop
lactic acidosis.