ACUTE COLCHICINE POISONING IN GEORGIA TSSU, CLINICAL TOXICOLOGY
Acute intoxication with colchicine is quite rare pathology and it is not described in Georgia until now. Despite rare clinical cases intoxication with colchicine deserves attention in order to avoid its severe complications. The most severe complication characteristic for colchicine intoxication is polyorganic insufficiency which frequently has fatal outcome. We represent the case from our practice. 17 years old girl on the background of nervous stress in purpose of suicide took 32 (1 mg) tablets of colchicine in total 0.7 mg/ kg of body weight (lethal dose is >0.8 mg/kg). Intoxication was expressed by acute respiratory insufficiency, hemoperitoneum, with disseminated intravascular coagulation, sepsis, swelling of brain. Parallel to symptomatic-detoxication treatment 60 doses of fresh frozen plazma (FFP) was used, 24 doses of thrombomass, as well as human granulocyte colony-stimulating factor (G-CSF) – Tevagrastim. It has to be noted that on IV day of intoxication based on corresponding study hemoperitoneum diagnosis was determined, surgical intervention was conducted. By US existence of fluid in both pleural cavities was determined. Punctate of hemorrhagic genesis was received by centesis. Assisted ventilation was conducted in post-surgical period. On XII day extubation was done. Active hairloss started on VII-VIII day finished with alopecia on XVI day. After intensive treatment despite existed severe complications the patient was placed on outpatient treatment from XX day with stabile hemodynamics. The case is interesting as rare case, it is distinguished with multiplicity and, what is important, it shows tha in case of timely conducted adequate treatment, the process is reversible and finishes with complete recovery. Before implementation of antitoxic serum (Colchicine specific antibodies) in clinical practice fresh frozen plazma (FFP) infusion can be considered as optimal mean for poison excretion, because the poison after absorption joins exactly 50% of plasma protein. In our opinion positive outcome of patient is conditioned by adequate and timely intervention which represents precondition for effective treatment of intoxicated patients.
2. Achtert G, Scherrmann JM, Christen MO. Pharmaco- kinetics/bioavailability of colchicine in healthy male volun- 127 128 teers. Eur J Drug MetabPharmacokinet. 1989;14:317-322.
3. Alayli G, Cengiz K, Canturk F, et al. Acute myopathy in a patient with concomitant use of pravastatin and colchicine. Ann Pharmacother. 2005;39:1358-61.
4. Finkelstein Y, Aks SE, Hutson JR, et al. Colchicine poisoning: the dark side of an ancient drug. ClinToxicol 2010;48:407 -14.
5. Nuki G, Colchiin: its mechanism of action and efficacy in crystalinducedinflammation. CurrRheumatol Rep 2008;10:218-27.
6. Achtert G, Scherrmann JM, Christen MO. Pharmacokinetics/biovailability of colchicine in healthy male volunteers. Eur J Drug Metabfarmacokinet. 1989;14:317-322