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

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.

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.

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).

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.