A case of severe colchicine poisoning, with toxicokinetic data

Marie-Charlotte Quinton-Bouvier , Nicolas Fabresse (1) , Sandra Bodeau (2, 3) , Pauline Caillard (2, 3) , Julien Maizel (4) , Kamel Masmoudi (2) , Jean-Claude Alvarez (5, 6) , Youssef Bennis (2, 3) , Anne-Sophie Lemaire-Hurtel (2)

1 2I - Infection et inflammation
2 CHU Amiens-Picardie
3 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
4 BoReal Study Group, Medical Intensive Care Unit and EA7517, Amiens University Hospital, F-80054, Amiens,
5 Université Paris-Saclay
6 Hôpital Raymond Poincaré [AP-HP]

Aim. - We describe a case of colchicine self -poisoning with a complete toxicokinetic analysis. The patient was treated for a microcrystalline polyarthritis with allopurinol and colchicine. After a conflict, he would have consumed colchicine (50 to 60 mg), paracetamol (8 to 16g), ibuprofen (8g) and ketoprofen (2 g) with whiskey (3 glasses). The patient was transferred to the intensive care unit (ICU). His clinical condition was stable, without loss of consciousness. In the first 24 hours, he had abundant diarrhea, vomiting and abnormal liver function progressing to acute liver failure at day 2. From day 3, haematological complications appeared (thrombocytopenia, leukopenia and anaemia). At day 5, the patient clinical condition has deteriorated hemodynamically, neurologically and respiratory requiring intubation. Renal function gradually alters from day 5, requiring daily dialysis from day 9. The patient presented alopecia at day 15. After 22 days in ICU he was transferred to nephrology unit for 21 days before leaving the hospital. Materials and methods. - Colchicine assay was performed by UHPLC coupled to a triple quadrupole TSQ Quantum Access Max (R) (Thermo Fisher Scientific (TM)). Successive assays were performed in order to follow the kinetics parameters, especially elimination of colchicine. Results/Discussion. - The first assay (H8) showed a massive poisoning (60 mu g/L) related to the supposed ingested dose. Toxicokinetic parameters were performed and revealed a very slow elimination (T1/2 =132 h) relative to the elimination half-life reported in the literature, a majored distribution volume (14.9 L/kg), and colchicine detection in plasma for 26 days. Conclusion. - Colchicine poisoning is rare but serious with high mortality despite the prompt management of patients. In this case with favorable outcome, only symptomatic treatments performed in intensive care have corrected the successive failures. (C) 2020 Societe Francaise de Toxicologic, Analytique. Published by Elsevier Masson SAS. All rights reserved.

Domaines: Sciences du Vivant [q-bio]

Marie-Charlotte Quinton-Bouvier, Nicolas Fabresse, Sandra Bodeau, Pauline Caillard, Julien Maizel, et al.. A case of severe colchicine poisoning, with toxicokinetic data. Toxicologie Analytique et Clinique, 2020, 32 (4), pp.301-307. ⟨10.1016/j.toxac.2020.05.001⟩. ⟨hal-03564797⟩