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]

  Case 3– A five-year-old girl presented to our emergency department for fever and gastroenteritis which started two days ago, and leucopenia (white blood count: 1200/mm3). [archivesofrheumatology.org]

  Colchicine is a lipophilic drug used to treat various conditions, including gout, primary biliary cirrhosis, familial Mediterranean fever, and several other disorders. It possesses a very narrow therapeutic index that predisposes to poisoning. [symptoma.com]

• Weakness

  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]

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

  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]

  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]

  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]

• 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

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

  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]

  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]

• 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]

  The majority of studies describe colchicine poisoning in three phases: Gastrointestinal phase - Within the first day following the ingestion of higher doses, the first symptoms appear, including diarrhea, nausea, vomiting, and abdominal pain, mimicking [symptoma.com]

  She complained of abdominal pain, vomiting, and diarrhea. We treated her conservatively and admitted her to the intensive care unit. [ekjm.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]

• 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]

  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]

  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]

• 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]

• 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]

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

  […] 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]

• 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]

  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]

  […] of plasma elimination of drug, due to colchicine attaches plasma proteins in %32–50 ratios.When she had fever, we observed closely clinical view of septic shock.After she was transferred to pediatric service of our hospital, It has been learned that alopecia [journals.lww.com]

• 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]

• 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]

  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]

  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]

  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

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

  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]

  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]

• 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]

  Over the next two days his liver and kidney enzymes were through the roof, a clear sign of multi-organ failure. He was sent to the ICU, placed on a ventilator, and eventually died of heart failure (2). [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]

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].

This alkaloid found in Colchicum autumnale is used primarily in the treatment of gout. [ncbi.nlm.nih.gov]

Colchicine is only indicated for intermittent use and patients will often initiate treatment themselves; therefore the potential exists for a severe drug interaction to occur. [medsafe.govt.nz]

Treatment for colchicine poisoning focuses on supportive therapy to keep the patient alive. Failing organ systems may be managed with dialysis and mechanical ventilation while the patient receives care. [wisegeek.net]

As mentioned earlier, colchicine is used as prophylaxis and treatment for gout flares and for Mediterranean fever treatment. This drug is known to interact with hundreds of medications such as warfarin ( Coumadin ), aspirin and Vitamin C. [overdoseinfo.com]

It is characterized by multiorgan involvement and by poor prognosis associated with overdose. In this article we present four children with colchicine poisoning to emphasize that colchicine poisoning has a large spectrum in childhood. [ncbi.nlm.nih.gov]

Colchicine intoxication is characterized by multiorgan involvement and by the poor prognosis associated with administration of large amounts of the drug. [einstein.pure.elsevier.com]

Early elevation of leukocyte count may predict poor prognosis. Following oral administration, colchicine rapidly and extensively diffuses into tissue. [archivesofrheumatology.org]

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty. [emergency.cdc.gov]

IMMUNOTOXICANTS IN HUMAN BEINGS 296 SURVEILLANCE OF ATRISK HUMANS EXPOSED TO IMMUNOTOXICANTS 297 CLINICAL ASSESSMENT OF IMMUNOTOXICITY 298 CLINICAL IMMUNOLOGY ENDPOINTS TO ASSESS NONSPECIFIC IMMUNITY 300 IMMUNE ENDPOINTS ADOPTED BY THE ATSDR 301 ENVIRONMENTAL EPIDEMIOLOGY [books.google.com]

Probable : A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for colchicine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case [emergency.cdc.gov]

| 2010 199 Epidemiology of hydrogen sulfide poisoning in Japan Iida, K. | 2010 206 Response of the Tokyo Fire Department to hydrogen sulfide poisoning incidents caused by detergents and other household chemicals Ishikawa, Y. | 2010 212 Clinical aspect [tib.eu]

Epidemiology The primary use of colchicine is in the prevention and treatment of painful exacerbations of gouty arthritis. [calpoison.org]

Epidemiologic data are consistent with an increase in the prevalence of gout. Acute gouty arthritis most commonly begins with the involvement of a single joint in the lower ex-tremities (85 – 90% of cases), often the first metatarsophalangeal joint. [flipper.diff.org]

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]

Pathophysiology Colchicine’s effectiveness in treating gout is due to its ability to decrease the response of granulocytes and other inflammatory cells. [calpoison.org]

Medical Center Ljubljana, Ljubljana, Slovenia (5) Professor, Head, Center for Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia (6) Associated Professor, Medical Faculty and Department for Cardiology, Institute for Pathophysiology [ccforum.biomedcentral.com]

How to prevent Colchicine Toxicity? An overdose in colchicine can be prevented by following the prescription orders of the physician. Additional dosage of the drug must not be done without the knowledge of the physician. [overdoseinfo.com]

In those patients that survive the initial phase of poisoning, G-CSF offers an effective method of treating the pancytopenia and preventing overwhelming septicaemia. Daily monitoring of the patient's haematological status is strongly recommended. [ncbi.nlm.nih.gov]

Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation. [books.google.com]

This prevents damage to the organs and body tissues and allows the colchicine to be eliminated through the urine. [ema.europa.eu]

There is no antidote or consistently effective therapy for colchicine toxicity so prevention is the key to avoiding colchicine toxicity and death. [dpic.org]

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.