Title: Don't eat that "wild garlic!" -- Colchicine toxicity.<br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p>
Colchicine is an alkaloid compound found in Colchicum autumnale that is often mistaken by foragers as wild garlic (Allium ursinum). Unintentional ingestion wild garlic or therapeutic misadventures among elderly population with history of gout often result in unintentional toxicity.</p>
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It is a potent inhibitor of microtubule formation and function involved in cell division and intracellular transport mechanism. Thus toxicity is related to diffuse cellular dysfunction of all major organs and results in significant morbidity and mortality.</p>
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Colchicine toxicity occurs in three phases:</p>
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Phase</p>
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Time</p>
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Signs and symptoms</p>
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Therapy</p>
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I</p>
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0 – 24 hr</p>
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· Nausea, vomiting, diarrhea</p>
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· Salt and water depletion</p>
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· Leukocytosis</p>
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· Antiemetic</p>
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· GI decontamination</p>
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· IV fluids</p>
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· Observation for leukopenia</p>
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II</p>
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1 – 7 days</p>
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· Sudden cardiac death (24 – 48 hr)</p>
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· Pancytopenia</p>
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· Acute kidney injury</p>
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· Sepsis</p>
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· Acute respiratory distress syndrome</p>
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· Electrolyte imbalance</p>
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· Rhabdomyolysis</p>
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· Resuscitation</p>
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· G-CSF</p>
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· Hemodialysis</p>
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· Antibiotics</p>
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· Mechanical ventilation</p>
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· Electrolyte repletion</p>
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III</p>
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>7 days</p>
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· Alopecia (2-3 weeks later)</p>
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· Myopathy, neuropathy, myoneuropathy.</p>
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Management</p>
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Primarily supportive care as no antidote is available.</li>
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ICU admission due to risk of sudden cardiac death in symptomatic patients.</li>
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Patients who does not manifest GI symptoms within 8 -12 hr are unlikely to be significantly poisoned.</li>
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