Observation 1
Patient S.O, 38 years old female, followed for depression for 3 months, admitted to the vital emergency room for colchicine poisoning 15h prior to arrival, with the aim of autolysis. She had ingested 40 tablets of colchicine 1 mg of a dose 0.72 mg/kg, without any notion of vomiting following ingestion. Initially, her vital signs, hemodynamically, respiratory and neurologically were stable, with a heartbeat of 96 beats per minute, blood pressure 131/66 mmHg, respiratory rate 15 breaths per minute, oxygen saturation 98% on air room. She reported gastrointestinal manifestations including abdominal pain, vomiting with liquid diarrhea. We proceeded to an evacuating treatment based on activated charcoal despite the 15h interval prior ingesting, as well as a symptomatic treatment based on rehydration. Emergency blood tests were requested, objectifying a hyperleukocytosis at 43,600, a PT at 23%, an elongated APPT at 71 sec (control at 30 sec), renal insufficiency with urea at 0.95 g / L, creatinine at 34 mg /L, hepatic cytolysis with AST at 431 and ALT at 151 IU/L, lipase a 1789 IU/L, CPK a 1464 IU/L and LDH has 1241 IU/L (table 1). An ECG was performed showing sinus tachycardia. Rehydration was set up, with frozen plasma pellet transfusion. The evolution at H+22 of her admission was marked by the appearance of a hemodynamic instability (low blood pressure 79/34 mmHg and rapid heart rate 142 bpm) having responded to the filling at the beginning then to vasopressors (Norepinephrine 40 mcg/kg/h), chest tightness, shortness of breath, and difficulty breathing, then the patient was altered on the neurological level which required an intubation with realization of a cerebral scanner returning normal.

She progressed to circulatory failure, respiratory dysfunction, liver and kidney failure and coagulopathy.

Because of her acute renal failure, hemodialysis was taken in consideration, but she had unstable circulation with low blood pressure (75-95/35-55 mmHg) even with high doses of norepinephrine (reached 200 mcg/kg/h).

Treatment by frozen plasma, antibiotics and proton pump inhibitors were administrated as well.

Patient’s vital functions deteriorated further and died 96hours approximately after admission.

Observation 2
Patient S.F., 30 years old male, with a history of drugs addiction (Hashish and MDMA commonly known as ecstasy), admitted to the vital emergency room for colchicine poisoning 14h prior arrival, with the aim of autolysis. He ingested 40 colchicine 1 mg tablets of a dose 0.67 mg/kg, without any notion of spontaneous or provoked vomiting following ingestion. Initially he was hemodynamically, respiratory and neurologically stable. He reported vomiting with abdominal and pelvic pain. We proceeded to an evacuating treatment based on activated charcoal, as well as a symptomatic treatment based on rehydration.

A biological assessment was requested, objectifying a hyperleukocytosis at 45,330/mm3, a platelet count at 215,000/mm3, a PT at 23%, an elongated APPT at 61 sec (control at 30 sec), renal failure with urea at 0.75 g/L, creatinine at 44 mg/L, hypochloremia at 83 mmol/L, hepatic cytolysis with AST at 539 IU/L and ALAT at 142 IU/L, lipase a 1039 IU/L, CPK a 644 IU/L and LDH has 892 IU/L. an ECG was performed showing repolarization disorders. Rehydration was set up, with frozen plasma transfusion. The evolution was marked by the appearance of hemodynamic instability justifying vascular filling, catecholamines at increasing doses guided by hemodynamic monitoring, respiratory and neurological distress at H+12 which required an intubation with realization of a cerebral scanner returning normal and thoracic in favor of alveolar hemorrhage. The patient had died in a picture of multi-visceral failure at H46 of his admission.

Table 1: Laboratory blood tests over time for patient S. O.