Combination of Multiple-Dose Activated Charcoal and Infusion Therapy That Led to Favorable Outcomes in Colchicine...

BACKGROUND The therapeutic margin of colchicine is narrow, and toxicity occurs easily. No standard treatment exists because its toxicokinetics are poorly understood. Symptoms are usually gastrointestinal, and dehydration occurs easily. Few reports have monitored serum and urinary colchicine levels. CASE REPORT A man in his 20s presented with nausea, vomiting, diarrhea, drowsiness, and dyspnea. He ingested 2 dried Colchicum autumnale bulbs (estimated colchicine: 6.24-15.6 mg) with an energy drink. Activated charcoal with laxative was administered at 27 hours post ingestion (h-PI), followed by multiple-dose activated charcoal (MDAC) every 6 hours (13 doses, 27-101 h-PI), high-volume fluid infusion (Ringer's acetate), and blood purification (hemodialysis [HD] at 48-52 h-PI; hemodiafiltration [HDF] at 71-75 and 98-102 h-PI). Serum colchicine was measured at 16 time points and urine at 11 time points. Serum colchicine at 27 h-PI was 50.3 ng/mL, and was temporally associated with a rapid decrease to 21.2 ng/mL at 35 h-PI, coinciding with initiation of infusion and activated charcoal. A secondary rise to 17.74 ng/mL occurred at 77 h-PI, approximately 2.4 hours after HDF1 completion. Urine colchicine was 110.0 ng/mL at 29 h-PI, then gradually decreased. Serum colchicine changed modestly (12.16 to 5.46 ng/mL) during HD. CONCLUSIONS In this case of severe colchicine poisoning, serial serum and urine concentration monitoring provided a time-resolved profile across concurrent interventions. The observed temporal associations support hypothesis generation regarding the potential roles of renal elimination and MDAC-mediated interruption of enterohepatic recirculation in colchicine clearance, while recognizing that concurrent therapies preclude attribution of effects to any single intervention.