> [!Key Points] > - Give activated charcoal to all overdoses > - essentially stops cells from functioning Antidote:: MDAC, early intubation, may need dialysis but is not itself dialysed see: [Murray Colchicine tox](x-devonthink-item://C8AE745C-C96E-4AEF-9010-D441840C6DF4?page=235&start=1893&length=10&search=COLCHICINE) # Risk assessment - \> 0.1mg/kg - potential for toxicity and death - gastrointestinal symptoms - \> 0.5mg/kg - 10% mortality - \> 0.8mg/kg - Severe multi organ failure ~100% mortality - cardiovascular collapse - coagulopathy - renal failure - # Toxic Mechanism Colchicine is a naturally occurring alkaloid. It is found in certain plants, including the autumn crocus (Colchicum autumnale) and glory lily (Gloriosa superba). It is used in the treatment of acute gout and has also been advocated in familial Mediterranean fever and [[Pericarditis]] . It binds tubulin and **prevents microtubule formation**, thus ==inhibiting mitosis, as well as other essential intracellular processes==. Following overdose, ==tissues with high cellular turnover (GIT, bone marrow) are preferentially affected==. ## toxicokinetics * Colchicine is rapidly absorbed * peak levels occurring from 0.5 to 2 hours post- ingestion. * Bioavailability is only 45% as a result of extensive first-pass metabolism. It is extensively tissue bound with a volume of distribution of 2 L/kg. * Elimination is by hepatic metabolism, with an elimination half-life of up to 30 hours following overdose. # Clinical features Usually presents with **severe gastroenteritis** followed by onset of multi-organ toxicity (if more than 0.5 mg/kg is ingested) in the second 24 hours ![[Pasted image 20230626192647.png]] # Treatment **Fluid loss and organ failure** - aggressive IVF resus +/- ionotropes - maintain normal electrolytes and acid/base - early respiratory arrest and cardiac arrest is anticipated; early intubation **Decontamination** - Administer activated charcoal 50 g (1 g/kg in children) as soon as possible to any patient who has potentially ingested >0.1 mg/kg of colchicine, because prevention of absorption of even a small amount may be life saving. - [[Decontamination#Multi dose activated charcoal]] indicated (controversial) Note: renal replacement therapy may be needed, but this does NOT eliminate colchicine