[Poisoning by the autumn crocus plant]

Colchicum autumnale intoxications: experience of the Poisons Information Centre, Austria 2002-2018

INTRODUCTION

Colchicine toxicity can occur when individuals unintentionally pick meadow saffron (Colchicum autumnale) instead of Allium ursinum. This study aimed to assess the severity of poisoning based on readily available clinical laboratory parameters evaluated within the first 24 hours of ingestion.

METHODS

Data from the Austrian Poisons Information Centre from 2002 to 2018 were evaluated for Colchicum autumnale poisoning and follow-up, including patients' clinical conditions, laboratory values, and serum colchicine concentrations.

RESULTS

Over the period of 17 years, 174 human cases of suspected Colchicum autumnale poisoning were reported to the Austrian Poisons Information Centre, including 163 cases of unintentional exposure (113 cases <15 years; 50 cases ≥ 15 years old). Follow-up was possible in seven of these cases; two of the patients died. Laboratory tests within the first 24 hours showed increased activities of lactate dehydrogenase (258-1974 U/L), aspartate aminotransferase (71-217 U/L), and creatine kinase (164-559 U/L) in five cases. One patient who consumed a small amount did not have any relevant laboratory changes. In another patient, the first blood sample was taken after 20 hours, which showed elevated aspartate aminotransferase (109 U/L) and lactate dehydrogenase (650 U/L) activities. Blood samples after 26.5 hours showed elevated creatine kinase (277 U/L) activity. Three patients had an elevated troponin concentration within the first 24 to 26.5 hours; one of them died. In five of these seven cases, toxicological analyses confirmed colchicine intoxication (serum colchicine concentration 2.0 - 6.5 µg/L).

CONCLUSIONS

When the ingestion of Colchicum autumnale is suspected in patients with gastrointestinal symptoms, elevated activities of lactate dehydrogenase, aspartate aminotransferase, and creatine kinase within the first 24 hours, careful monitoring is required. Serum creatinine and troponin concentrations, together with haematological parameters, should be measured to allow better clinical assessment. As only a small number of patients have been reported, further detailed case reports are needed to better predict the prognosis of intoxications with Colchicum autumnale.

Accidental poisoning with autumn crocus (Colchicum autumnale): a case series

INTRODUCTION

Colchicum autumnale (autumn crocus) is a plant that contains highly toxic alkaloid colchicine. The aim was to evaluate accidental C autumnale poisoning and assess serum troponin as a prognostic parameter.

METHODS

In this study, we retrospectively included all adult patients with a history of accidental C autumnale ingestion and serum colchicine confirmation during the study period from 2000 to 2019. The medical files of enrolled patients were reviewed. Literature search of accidental ingestions of C autumnale was done.

RESULTS

Over the study period of 20 years, 16 adult patients were admitted to the University Medical Centre Ljubljana due to acute colchicine poisoning after ingestion of C autumnale. They all mistakenly ingested C autumnale's leaves instead of Allium ursinum in the spring and had confirmed colchicine in serum by GC-MS or LC-MS/MS (15.5 µg/L (0.5-80 µg/L)). They developed vomiting and diarrhoea within 1-9 h after the meal. Vomiting within 2 h was associated with lethality (p=.04). Bone marrow suppression developed in 15 patients (94%). Acute myocardial injury with positive troponin I (>0.10 µg/L) developed in five patients; lethal cardiogenic shock with decreased cardiac output and hypotension occurred in four of these patients despite supportive therapy. Positive troponin I ultra (>0.10 µg/L) was associated with need for intensive support therapy (p=.01), decreased cardiac output (p=.01) and death (p=.01). The mortality was 4/16 (25%). On review, we found 58 cases; 95% cases accidently ingested leaves of C autumnale instead of A ursinum. Troponin I was reported in 3% cases. The lethality of this and reviewed cases was 35% (26/74).

CONCLUSIONS

In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice in the spring, especially when wild garlic is mentioned, we should always consider C autumnale poisoning. Cardiogenic shock can be predicted by a positive serum troponin I measurement.

Colchicine poisoning: a case report and review of literature

Colchicine, a natural pseudo-alkaloid found in plants such as the Colchicum autumnale and Gloriosa superba has tremendous medicinal properties, but if misused by an unqualified person can result in fatal consequences. We report a case of colchicine poisoning in an adult man as a result of consumption of the herb G. superba by a 50-year-old man and review the literature.

Colchicine exposures: the Texas experience

OBJECTIVES

Colchicine is a relatively uncommon toxin, but is known to precipitate severe multiorgan failure in overdose. Little is known about exposure patterns and outcomes in cases of colchicine ingestion. Our goal was to add to toxicologic knowledge through a database review and descriptive study of colchicine exposures.

METHODS

Texas Poison Center Network Data was reviewed for the years 2000 to 2005, and all reports of colchicine exposures were reviewed.

RESULTS

A total of 79 cases were found in the time period studied. The most common exposure reasons were unintentional-therapeutic error (33%), unintentional-general (28%), and intentional-suspected suicide (18%). Medical outcomes included no effect (24%), minor effect (20%), moderate effect (15%), and major effect (3%). The most common clinical findings included vomiting (20%), diarrhea (17%), and abdominal pain (7%). The most commonly employed therapies were dilution (28%), single-dose activated charcoal (26%), cathartics (16%), and gastrointestinal lavage (15%).

CONCLUSION

The majority of cases of exposure produced no significant effects, and fatality was uncommon in this sample. Colchicine is a relatively uncommon toxin among therapeutic drugs, and though capable of it, is rarely responsible for significant morbidity or mortality. Meticulous exposure record keeping at poison centers is a key to the study of patterns of toxicity with uncommon toxins such as colchicine.