Colchicine intoxication: a report of two suicide cases
A 23-year-old 50 kg female patient was admitted to a local hospital with the complaints of nausea and vomiting 4 hours after taking 50 mg or 1 mg/kg (100 tablets of 0.5 mg) colchicine for suicide. She had a history of FMF. Stomach lavage and activated charcoal gastric decontamination was performed and she was transferred to the Kayseri Training and Research Hospital 10 hours after ingestion. She was conscious, orientated and cooperative, and complained of diarrhea and abdominal pain. She had pale and cold skin, and her vital signs in the emergency facility revealed a blood pressure of 94/58 mmHg, body temperature of 36.8°C, respiratory rate of 16 breaths/minute, and heart rate of 77 beats/minute. She had tenderness on the epigastrium, and other system examinations were unremarkable. The patient was admitted to the intensive care unit. The results of initial laboratory studies were: white blood cells (WBC), 19.330 (103 μL); hemoglobin, 15.4 g/dL; hematocrit, 45%; platelets (PLTs), 250,000/mm3; aspartate aminotransferase (AST), 87 U/L; alanine aminotransferase (ALT), 19 U/L; sodium, 143 mmol/L; potassium (K), 3.8 mmol/L; calcium (CA), 8.3 mmol/L; total creatine kinase (Total-CK), 116 U/L; serum creatine kinase myocardial band isoenzyme (CK-MB), 45 U/L; lactate dehydrogenase (LDH), 1,568 U/L; troponin I, 0.39 ng/mL; D-dimer, 6,795 ng/L; international normalized ratio (INR), 2.27; activated partial thromboplastin time (aPTT), 27.7 seconds; blood urea nitrogen (BUN), 15 mg/dL; serum creatinine (Cr), 1.0 mg/dL. Serologic tests for hepatitis B and hepatitis C were negative. Blood gas values were: pH, 7.372; partial pressure of carbon dioxide (pCO2), 41.6 mmHg; (bicarbonate) HCO3, 23 mmol/L; base excess (BE), −1.2 mmol/L. Following the recommendation of the contacted poison control center, gastric lavage was performed again and activated charcoal was given every hour for 6 hours (0.25 g/kg per hour) to reduce the intestinal colchicine absorption. Sodium bicarbonate at a dose of 80 mEq was replaced in 12 hours. Electrolytes and blood gases were monitored every 6 hours. shows the results of blood gas monitoring. On the 12th hour of her admission, lactate was 10.4 mmol/L and HCO3 <15 mmol/L. The patient developed high anion gap (AG) metabolic acidosis due to lactic acidosis. Hemodialysis was performed because of the patient’s insufficient urine output. Intravenous fluids and positive inotropic agents were used for persistent low central venous pressure. On follow-up of the patient, AST, ALT, Total-CK, CK-MB, troponin I, LDH, and INR rose progressively and PLTs declined (). Sinus tachycardia was determined by electrocardiography, and echocardiography revealed normal systolic function of the left ventricle, with an ejection fraction of 50%–55%. Peripheral blood smear revealed Blood tests showed raised D-dimer, aPTT, prothrombin time and INR, and decreased fibrinogen. Eventually disseminated intravascular coagulopathy (DIC) developed. Fresh frozen plasma and platelet infusion at a dose of 1 unit per 10 kg was given. K and Ca were also replaced for the treatment of hypokalemia and hypocalcemia. At 42 hours following hospital admission, the patient’s general condition worsened. She had a heart rate of 132 bpm, respiratory rate of 33 breaths/minute, peripheral oxygen saturation of 94%, a Glasgow coma scale of 12, and invasive arterial blood pressure was 82/51 mmHg. Blood gas analyses were pH, 7.225; pCO2, 42.2 mmHg; arterial oxyhemoglobin saturation (SaO2), 96%; HCO3, 15 mmol/L; BE, −10.4 mmol/L. The patient had diffuse abdominal pain, tenderness on palpation, and hyperactive bowel sounds. Blood samples taken from the central venous catheter revealed WBC, 18.220 (103 μL); hematocrit, 44.1%; PLTs, 73,000/mm3; ALT, 93 U/L; AST, 561 U/L; BUN, 11 mg/dL; Cr, 1.3 mg/dL; Total-CK, 1,415 U/L; CK-MB, 135 U/L; LDH, 6,105 U/L; troponin I, 34.04 ng/mL; INR, 6.18; aPTT, 157.3 seconds. The patient was thought to have developed lactic acidosis, DIC, and multiorgan failure with rhabdomyolysis due to colchicine intoxication, and supportive treatments (fresh frozen plasma, platelet infusion, nasal oxygen, etc) were continued. Hemodialysis was performed again for decreased urine output (400 cc/day). At 54 hours following hospital admission, cardiopulmonary arrest developed. She responded to resuscitation after 50 minutes, and mechanical ventilation was performed. Blood gas analyses were: pH, 6.665; pCO2, 76 mmHg; HCO3, 5.2 mmol/L; BE, −26 mmol/L. Because of continuing lactic acidosis, hemodialysis was performed again, and the duration of hemodialysis was prolonged. At 58 hours following her admission, the patient went into cardiac arrest again, remained completely unresponsive to resuscitation, and died.