Colchicine toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Derived from C. autumnale (wild saffron, meadow saffron, autum crocus, naked lady) and G. superba (glory lily) [[File:Colchicum autumnale | *Derived from C. autumnale (wild saffron, meadow saffron, autum crocus, naked lady) and G. superba (glory lily) | ||
**C. autumnale resembles wild garlic [[File:Colchicum autumnale 2c.JPG|thumb|C. autumnale]] | |||
**G. superba may be confused for sweet potatoes | **G. superba may be confused for sweet potatoes [[File:Gloriosa superba (Glory Lily) in Hyderabad, AP W IMG 0224.jpg|thumb|G. superba]] | ||
*First published in the first century in ''Pedanius Dioscorides De Materia Medica'' | *First published in the first century in ''Pedanius Dioscorides De Materia Medica'' | ||
===Uses=== | ===Uses=== | ||
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*Serum half-life 9-108 minutes | *Serum half-life 9-108 minutes | ||
*Toxicity usually occurs at levels >3ng/ml | *Toxicity usually occurs at levels >3ng/ml | ||
==Clinical Features== | ==Clinical Features== | ||
===Triphasic=== | ===Triphasic=== | ||
| Line 86: | Line 87: | ||
*Coagulation factors | *Coagulation factors | ||
*CPK | *CPK | ||
* | *[[Urinalysis]] | ||
*EKG | *EKG | ||
*CXR | *CXR | ||
*Depending on clinical situation | *Depending on clinical situation | ||
**Troponin | **[[Troponin]] | ||
**ABG | **ABG | ||
**Lactate | **Lactate | ||
| Line 97: | Line 98: | ||
*Supportive care | *Supportive care | ||
*GI Decontamination | *GI Decontamination | ||
**[[ | **Oro[[gastric lavage]] in patients who present within 1-2 hours without vomiting | ||
**[[Activated charcoal]] and consider [[ | **[[Activated charcoal]] and consider [[Multidose activated charcoal]] | ||
*Antidotal therapy | *Antidotal therapy | ||
**Colchine-specific Fab fragments | **Colchine-specific Fab fragments | ||
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*All symptomatic patients require admission to ICU | *All symptomatic patients require admission to ICU | ||
*Patients who do not develop GI symptoms within 8-12 hours after ingestion likely have not developed significant poisoning | *Patients who do not develop GI symptoms within 8-12 hours after ingestion likely have not developed significant poisoning | ||
*Consult Toxicology or | *Consult Toxicology or [[poison control]] | ||
==References== | ==References== | ||
Latest revision as of 20:55, 1 July 2019
Background
- Derived from C. autumnale (wild saffron, meadow saffron, autum crocus, naked lady) and G. superba (glory lily)
- C. autumnale resembles wild garlic
- G. superba may be confused for sweet potatoes
- First published in the first century in Pedanius Dioscorides De Materia Medica
_in_Hyderabad,_AP_W_IMG_0224.jpg)
Uses
- Gout
- Familial Mediterranean fever
- Pericarditis
Toxicokinetics
- Inhibitor of microtubule formation and function
- Rapidly absorbed in the jenjunum and ileum
- Bioavaiability of 25-50%
- Lipid soluble
- Volume of distribution from 2.2-12L/kg, may increase to 21L/kg in overdose
- 50% bound to plasma proteins
- Peak serum concentration in 1-3 hours
- Metabolized by liver via CYP3A4
- Undergoes enterohepatic recirculation
- Serum half-life 9-108 minutes
- Toxicity usually occurs at levels >3ng/ml
Clinical Features
Triphasic
- Phase I
- Onset 12-24 hours post ingestion
- GI manifestations
- Phase II
- 24 hours- several days
- Wide spread organ dysfunction
- Phase III
- Recovery or death
- Lasts approximately 1 week
GI
- Vomiting and diarrhea
- Abdominal pain
Hematopoietic
- Peripheral leukocytosis followed by profound leukopenia
- Pancytopenia within 48-72 hours
- Recovery of all cell lines occurs if patient survives
Cardiovascular
- Dysrhythmias
- Cardiac arrest
- Occurs within 24-36 hours
Pulmonology
Neurologic
- Myopathy
- Neuropathy
- Myoneuropathy
- Seizures
Musculoskeletal
- Rhabdomyolysis
Differential Diagnosis
Heavy metal toxicity
- Aluminum toxicity
- Antimony toxicity
- Arsenic toxicity
- Barium toxicity
- Bismuth toxicity
- Cadmium toxicity
- Chromium toxicity
- Cobalt toxicity
- Copper toxicity
- Gold toxicity
- Iron toxicity
- Lead toxicity
- Lithium toxicity
- Manganese toxicity
- Mercury toxicity
- Nickel toxicity
- Phosphorous toxicity
- Platinum toxicity
- Selenium toxicity
- Silver toxicity
- Thallium toxicity
- Tin toxicity
- Zinc toxicity
Evaluation
- Colchicine levels do not return in a timely manner
- No correlation with severity of illness
- >3.0ng/ml generally associated with toxicity
- BMP
- Including calcium, magnesium, and phosphorus
- LFTs
- CBC
- Coagulation factors
- CPK
- Urinalysis
- EKG
- CXR
- Depending on clinical situation
- Troponin
- ABG
- Lactate
- Fibrinogen
Management
- Supportive care
- GI Decontamination
- Orogastric lavage in patients who present within 1-2 hours without vomiting
- Activated charcoal and consider Multidose activated charcoal
- Antidotal therapy
- Colchine-specific Fab fragments
- Not commercially available
- Granulocyte-colony stimulating factor (G-CSF)
- useful in treating patients who develop leukopenia and thrombocytopenia
- Colchine-specific Fab fragments
- Extracorporeal elimination
- No benefit
Disposition
- All symptomatic patients require admission to ICU
- Patients who do not develop GI symptoms within 8-12 hours after ingestion likely have not developed significant poisoning
- Consult Toxicology or poison control
References
Schier, J. Colchicine, Podophyllin and the Vinca Alkaloids. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 537-547