The clinical presentation of colchicine poisoning stems from the potent effects of the drug [1] [2] [3]. Colchicine disrupts the assembly of microtubules and higher doses can promote severe disruption of various cellular mechanisms [1] [3] [4]. The majority of studies describe colchicine poisoning in three phases [1] [2] [5]:

• Gastrointestinal phase - Within the first day following the ingestion of higher doses, the first symptoms appear, including diarrhea, nausea, vomiting, and abdominal pain, mimicking gastroenteritis [1] [3].
• Multi-organ damage phase - Considered as the critical period of colchicine poisoning, the first week is characterized by the onset of severe and progressive muscle weakness accompanied by failure of several organs, including the kidneys, liver, and bone marrow [1] [2] [3] [5] [6]. Bone marrow suppression is a known complication that may lead to sepsis, whereas hypovolemic shock and cardiac failure are the most important causes of death from colchicine poisoning [1] [5]. Neuropathy and myopathy are also described in many patients, particularly in cases of chronic ingestion of subtoxic or toxic doses [3] [6]. Some studies also mention neurological symptoms (stupor, coma, seizures, or delirium), dysrhythmias, pancreatitis, and rhabdomyolysis [2].
• Recovery phase - With early and adequate treatment, a complete recovery can occur in a few weeks, although some sequelae, including severe neuromuscular disability, has been documented [6].

• Fever

  The use of colchicine was due to diagnosis of Familial Mediterranean fever (FMF) in the families of 8 patients, diagnosis of Behçet disease in 1 patient's father, diagnosis of Behçet disease in 1 patient herself, and diagnosis of FMF in 6 patients themselves [ncbi.nlm.nih.gov]

  Some patients report a burning feeling in the mouth and throat, and develop a fever. Kidney failure can onset, along with severe internal bleeding. Treatment for colchicine poisoning focuses on supportive therapy to keep the patient alive. [wisegeek.net]

  and now most commonly used to treat gout, familial Mediterranean fever More Details, [1] Behçet's disease, [1] atrial fibrillation following cardiac tissue ablation, [2] and pericarditis. [2], [3] Colchicine poisoning is an uncommon, but potentially [ijtrichology.com]

• Weakness

  Some patients develop neuromyopathy (mild to severe myalgia, muscle weakness, numbness and fatigue) with chronic dosing, mostly without GI symptoms. [dpic.org]

  Multi-organ damage phase - Considered as the critical period of colchicine poisoning, the first week is characterized by the onset of severe and progressive muscle weakness accompanied by failure of several organs, including the kidneys, liver, and bone [symptoma.com]

  A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum–like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. [pediatrics.aappublications.org]

  Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]

  The drug has a wide range of applications: used not only in the treatment of weak erection and premature ejaculation, but also to improve potency and endurance of the reproductive system, increase the duration of sexual intercourse. [vumxxdo.gq]

• Anemia

  On laboratory investigation severe thrombocytopenia and leukopenia, mild anemia, a moderate increase in aspartate aminotransferase and alanine aminotransferase levels were detected. [pediatrics.aappublications.org]

  Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side effects include fetal damage in pregnant women anemia [resource4thepeople.com]

  The acute toxicity of colchicine is well known: abdominal pain, gastroenteritis with vomiting and diarrhea, hypokalemia, metabolic acidosis, aplastic anemia complicated by hemorrhage, and infection can result (1,3-6). [thefreelibrary.com]

  More seriously, Colchicine can reduce the white blood cells count, damage bone marrow and lead to anemia (lower than normal number of red blood cells / not enough hemoglobin). [mypeyronies.com]

  Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]

• Fatigue

  Some patients develop neuromyopathy (mild to severe myalgia, muscle weakness, numbness and fatigue) with chronic dosing, mostly without GI symptoms. [dpic.org]

  Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]

• Intravenous Administration

  CLINICAL FEATURES: Colchicine poisoning presents in three sequential and usually overlapping phases: 1) 10-24 h after ingestion - gastrointestinal phase mimicking gastroenteritis may be absent after intravenous administration; 2) 24 h to 7 days after [ncbi.nlm.nih.gov]

  Systemic toxicity associated with intravenous administration of colchicine-guidelines for use. J Rheumatol 1988;15:495-9. (7.) Murray SS, Kramlinger KG, McMichan JC, Mohr ON. Acute toxicity after excessive ingestion of colchicine. [thefreelibrary.com]

• Sore Throat

  Other side effects of Colchicine include: Fatigue Weakness Sore throat Rash Numbness Allergic reactions such as hives, swelling of lips/face/tongue, closing of throat, difficulty breathing Unsuspected bleeding and brusing More serious Colchicine side [resource4thepeople.com]

  The next patient has a sore throat. House makes him wait. Cuddy comes in an examines the patient. House acts like he's surprised the patient has a sore throat. Cuddy sends the patient home to drink hot tea. [house.wikia.com]

• Cough

  In another scene, Brandon comments on how the cough medicine Cameron gives him has a letter on them which his old ones do not. In the pharmacy, the determined House finds the colchicine pill that looks similar to the cough medicine. [thephysicianslibrary1.blogspot.com]

  However, it turns out they gave the patient the cough medicine after all. House has to admit he was wrong although his theory was perfect. However, he now thinks the cough medicine may have caused the problem. [house.wikia.com]

• Vomiting

  A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]

  Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]

• Nausea

  A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]

  Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]

• Diarrhea

  A 48-year-old male was admitted to hospital complaining of vomiting, nausea and diarrhea following ingestion of the plant and died in four days. [ncbi.nlm.nih.gov]

  Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]

  While one person merely complained about a 3-day episode of nausea, vomiting and watery diarrhea, the second person died of multi-organ system derangements 48 h after the ingestion of the colchicum leaves. [maltawildplants.com]

  Possible side effects of taking this drug include vomiting, nausea, stomach pain and diarrhea [1, 2, 3, 4]. How much is Colchicine Toxicity? The exact Colchicine dose that causes toxicity symptoms is still unknown. [overdoseinfo.com]

• Abdominal Pain

  Patients with colchicine toxicity initially present with gastrointestinal symptoms of nausea, vomiting, diarrhea and abdominal pain. [calpoison.org]

  Early symptoms include abdominal pain, nausea, vomiting and diarrhoea. Symptoms occurring after 1 to 7 days include: confusion, cardiac, renal and hepatic impairment, respiratory distress, hyperpyrexia and bone marrow depression. [medsafe.govt.nz]

  Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]

  The patient may manifest with diarrhea, vomiting, nausea, abdominal pain and a significant loss of fluid. Peripheral leukocytosis may also be seen in patients. The second stage may happen around 24-72 hours after the ingestion. [overdoseinfo.com]

  Acute colchicine toxicity is described in three phases, usually beginning with GI symptoms in the first 24 hours: abdominal pain, diarrhea, nausea and vomiting. Dehydration and leukocytosis may also occur. [dpic.org]

• Acute Abdomen

  One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. CONCLUSIONS: Mortality of colchicine toxicity is high and quick assessment is absolutely required. [ncbi.nlm.nih.gov]

• Hypotension

  Delayed symptoms of colchicine toxicity include seizures, cardiac dysrhythmias, hypotension, shock, coagulopathy, pancytopenia and respiratory, renal, and hepatic failure. [calpoison.org]

  Colchicine poisoning should be suspected in patients with access to the drug and the typical toxidrome (gastroenteritis, hypotension, lactic acidosis, and prerenal azotemia). [ncbi.nlm.nih.gov]

  In the ED, she had epigastric pain, nausea, and hypotension, which can develop in stage 1 of colchicine intoxication. [kjccm.org]

  The patient became hypotensive and a dopamine and dobutamine infusion was started. Unfortunately, the patient subsequently developed bradycardia, which progressed to asystolic cardiac arrest, and he died in the 3rd hour of admission. [thefreelibrary.com]

  In our case the compensatory excretion was not possible since the patient's chronic renal insufficiency was additionally deteriorated by hypotension, hypoxia and rhabdomyolysis due to the colchicine effect on muscle cells. [ccforum.biomedcentral.com]

• Hepatomegaly

  This includes kidney damage, which causes low urine output and bloody urine ; low white blood cell counts that can last for several days; anemia ; muscular weakness; liver failure ; hepatomegaly ; bone marrow suppression ; thrombocytopenia ; and ascending [en.wikipedia.org]

• Alopecia

  Massive generalized alopecia after poisoning by Gloriosa superba. Br Med J 1966;1:1023-4. 10. Duff IF, Mikkelsen WM, Salin RW. Alopecia totalis after desacetylmethylcolchicine therapy of acute gout; report of a case. N Engl J Med 1956;255:769-70. [ijtrichology.com]

  One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. CONCLUSIONS: Mortality of colchicine toxicity is high and quick assessment is absolutely required. [ncbi.nlm.nih.gov]

  For survivors, alopecia and leukocytosis occur in the third phase. Toxicity does not always occur in phases. GI symptoms can occur at any time. [dpic.org]

  It usually starts after day seven when there is resolution of organ failure, rebound leukocytosis and alopecia. Rebound leukocytosis and alopecia occurred in first and third patients in our study. [archivesofrheumatology.org]

• Purpura

  Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]

  Resistance 1 2 Recruiting Treatment Colchicine / Coronary Artery Disease / Inflammatory Reaction / Severe or persistent diarrhea / Type 2 Diabetes Mellitus / White Blood Cell 1 2 Recruiting Treatment Cutaneous Polyarteritis Nodosa / Henoch-Schönlein Purpura [drugbank.ca]

• Eruptions

  Improve your competency and readiness with the latest guidance on volcanic eruptions, extreme sports, splints and slings, wilderness cardiology, living off the land, aerospace medicine, mental health in the wilderness, tactical combat casualty care, and [books.google.com]

• Myopathy

  Clinical features, pathophysiology, and treatment of polymyositis and dermatomyositis; inclusion body myositis; metabolic myopathies; drug-induced myopathies; muscular dystrophies and neurologic diseases; laboratory testing and imaging; electrophysiological [books.google.com]

  Co-administration with statins may increase the risk of myopathy. MECHANISMS OF TOXICITY: Colchicine's toxicity is an extension of its mechanism of action - binding to tubulin and disrupting the microtubular network. [ncbi.nlm.nih.gov]

  Neuropathy and myopathy are also described in many patients, particularly in cases of chronic ingestion of subtoxic or toxic doses. [symptoma.com]

  […] considered as second-line therapy of gout because it has a narrow therapeutic window and a high rate of side effects. [4] The main untoward effects of colchicine include nausea, vomiting, diarrhoea, and abdominal pain, bone marrow suppression and proximal myopathy [indianjnephrol.org]

  Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]

• Kidney Failure

  Kidney failure can onset, along with severe internal bleeding. Treatment for colchicine poisoning focuses on supportive therapy to keep the patient alive. [wisegeek.net]

  Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]

  The tests show the antibiotics didn't cause the kidney failure. House informs them the patient is getting better. House tells Wilson he criticizes his fellows to make them feel terrible because it will make them better doctors. [house.wikia.com]

  The urine showed signs of liver and kidney failure (stage 2), and died after the third day. The meadow was investigated, and there was evidence of grazing upon Colchicum autumnale. [naturespoisons.com]

  failure (including those on dialysis ). [18] About 10-20 percent of a colchicine dose is excreted unchanged by the kidneys; it is not removed by hemodialysis. [en.wikipedia.org]

• Oliguria

  He also complained oliguria on day 6. Patient's wife has brought the tuber. It was identified as G. superba. Patient revealed that he had consumed 250 g of the tuber along with water. Patient had no history of any illness. [indianjnephrol.org]

  Oliguria and then anuria ensued and were not responsive to supportive measures. He continued to deteriorate and death occurred approximately 11 hours after admission. [emj.bmj.com]

  Kidney damage, evidenced by hematuria and oliguria, may occur. Muscular weakness may be marked, and ascending paralysis of the central nervous system may develop; the patient usually remains conscious. Delirium and convulsions may occur. [drugbank.ca]

• Anuria

  Oliguria and then anuria ensued and were not responsive to supportive measures. He continued to deteriorate and death occurred approximately 11 hours after admission. [emj.bmj.com]

  Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]

• Confusion

  We report a further case in which two persons confused this highly poisonous plant with wild garlic ( Allium ursinum ), a popular spice in the Central European cuisine. [maltawildplants.com]

  Symptoms occurring after 1 to 7 days include: confusion, cardiac, renal and hepatic impairment, respiratory distress, hyperpyrexia and bone marrow depression. [medsafe.govt.nz]

  It has a narrow therapeutic index, with no clear-cut distinction between nontoxic, toxic, and lethal doses, causing substantial confusion among clinicians. [ncbi.nlm.nih.gov]

  Mary Louise Yoder Milman said an overdose of the substance would cause abdominal pain, nausea and vomiting at first, and then lead to confusion, a drop in blood pressure, shock, respiratory distress, kidney failure and eventually cardiovascular collapse [syracuse.com]

  A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum–like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. [pediatrics.aappublications.org]

• Seizure

  Delayed symptoms of colchicine toxicity include seizures, cardiac dysrhythmias, hypotension, shock, coagulopathy, pancytopenia and respiratory, renal, and hepatic failure. [calpoison.org]

  After the sedative drug (midazolam, 3 mg/hr.) used during the MV was discontinued, seizure-like movements were not observed. [kjccm.org]

  Some studies also mention neurological symptoms (stupor, coma, seizures, or delirium), dysrhythmias, pancreatitis, and rhabdomyolysis. [symptoma.com]

  Neurologic symptoms are also evident, including seizures, confusion, and delirium ; children may experience hallucinations. [en.wikipedia.org]

• Peripheral Neuropathy

  Effects of long-term colchicine toxicity include agranulocytosis, thrombocytopenia, low white blood cell counts, aplastic anemia, alopecia, rash, purpura, vesicular dermatitis, kidney damage, anuria, peripheral neuropathy, and myopathy. [26] No specific [en.wikipedia.org]

• Neglect

  The many challenges confronting healthcare systems include: Operation at near-capacity much of the time, with severely limited ability to absorb the increasing burdens of potential public health issues Serious neglect of the public health system for many [books.google.com]

• Unresponsive to Pain Stimuli

  On physical examination she was unresponsive to painful stimuli, skin was cool and dry, and pupils were midposition and not reactive. Bowel sounds were normal and lungs were clear bilaterally. [calpoison.org]

Although the presentation of colchicine poisoning consists of nonspecific gastrointestinal and systemic symptoms, the physician must obtain a detailed patient history and conduct a thorough laboratory workup in order to narrow down the differential diagnosis. Colchicine is extensively metabolized in the liver (and in the kidneys to some extent), meaning that several drugs may enhance its effect, eg. statins, antimicrobial drugs (clarithromycin, erythromycin, and ketoconazole), cyclosporine, but also grapefruit juice [1] [7]. For this reason, medication history is particularly important for identifying possible poisoning due to colchicine [1]. After assessing the course and progression of symptoms, a comprehensive laboratory assessment is mandatory. Typical findings in colchicine poisoning are high creatine phosphokinase levels (CPK, or CK), lactic acidosis, azotemia (pre-renal), electrolyte imbalance, and abnormally high liver transaminases, whereas coagulopathies are also found in some cases [1] [2] [6]. Leukocytosis is seen in the initial stages, but severe leukopenia and pancytopenia are detected in the multi-organ damage phase, due to bone marrow suppression [2]. Electrophysiologic studies may be of use in the setting of an undisclosed diagnosis, showing specific patterns of motor unity myopathy in muscles of the trunk and the proximal limbs and complex repetitive discharges [5] [7].

1. Finkelstein Y, Aks SE, Hutson JR, et al. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010;48(5):407-414.
2. Aghabiklooei A1, Zamani N, Hassanian-Moghaddam H, Nasouhi S, Mashayekhian M. Acute colchicine overdose: report of three cases. Reumatismo. 2014;65(6):307-311.
3. Iosfina I, Lan J, Chin C, Werb R, Levin A. Massive Colchicine Overdose with Recovery. Case Rep Nephrol Urol. 2012;2(1):20-24.
4. Maxwell MJ, Muthu P, Pritty PE. Accidental colchicine overdose: a case report and literature review. Emerg Med J. 2002;19:265–267.
5. Ozdemir R, Bayrakci B, Teksam O. Fatal poisoning in children: acute colchicine intoxication and new treatment approaches. Clin Toxicol (Phila). 2011;49(8):739-743.
6. Medani S, Wall C. Colchicine toxicity in renal patients - Are we paying attention? Clin Nephrol. 2016;86(2):100-105.
7. Huh K, Joung JY, Jeong H, et al. Colchicine-induced myoneuropathy in a cyclosporine-treated renal transplant recipient. Kidney Res Clin Pract 2013;32(2):74-77.