title: Colchicine intoxication: a report of two suicide cases.
abstract: Colchicine, an old and well-known drug, is an alkaloid extracted from Colchicum autumnale and related species. Colchicine inhibits the deposition of uric acid crystals and is an inhibitor of mitosis. Nausea, vomiting, abdominal pain, and diarrhea, with a massive loss of fluid and electrolytes are the first clinical symptoms of colchicine poisoning. Stomach lavage and rapid gastric decontamination with activated charcoal are crucial. An acute dose of about 0.8 mg/kg of colchicine is presumed to be fatal. We report the clinical outcomes of two different cases of colchicine intoxication for attempted suicide. The dose required for morbidity or mortality varies significantly. The dose of 1 mg/kg in the first case was directly related with mortality, while the dose of 0.2 mg/kg in the second was related with survival. The other difference between the patients was the time of arrival to hospital after ingestion. This period was 4 hours for case 1 and only 1, hour for case 2. The initiation of treatment later than 2 hours after ingestion of colchicine may significantly impair treatment because the absorption time for colchicine after oral administration is about 30-120 minutes. The rising lactate level and high anion gap metabolic acidosis in our patient (case 1) were attributed to lactic acidosis, so hemodialysis was performed, and the duration of hemodialysis was prolonged. Lactic acidosis in the first case was one of the reasons for mortality. The most important parameters which define the chance of survival are the dose of ingested drugs and the arrival time to hospital after ingestion. The patients must be monitored closely for lactic acidosis and the decision to start hemodialysis must be made promptly for patients who develop lactic acidosis.
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Abdulsamet
authors.initials: A
authors.lastname: Erden
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Hatice
authors.initials: H
authors.lastname: Karagoz
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Hasan Hüseyin
authors.initials: HH
authors.lastname: Gümüscü
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Samet
authors.initials: S
authors.lastname: Karahan
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Basak
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Aykas
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Bulut
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Cetinkaya
authors.affiliation: Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Avci
authors.affiliation: Gastroenterology Department, Kayseri Training and Research Hospital, Kayseri, Turkey.
authors.forename: Orhan Kürsat
authors.initials: OK
authors.lastname: Poyrazoglu
keywords: colchicine intoxication; metabolic acidosis; mortality