Chemical structure: alkaloid
Mechanism of action: blocks mitosis in metaphase after binding to tubulin
Sources of colchicine:
(1) Colchicum autumnale (autumn crocus, saffron)
(2) Gloriosa superba (glory lily)
(3) therapeutic agent for gout
Initial clinical findings during the first 24 hours after exposure:
(1) pain in mouth, throat and abdomen
(2) severe nausea and vomiting
(3) diarrhea
(4) hypovelemia and electrolyte imbalances
(5) consumptive coagulopathy with increased fibrinolysis (DIC)
Clinical findings during first week after exposure:
(1) bone marrow depression with anemia, thrombocytopenia and neutropenia
(2) secondary infection
(3) spontaneous hemorrhage
(4) confusion, delirium, coma
(5) convulsions
(6) ARDS
(7) cardiac arrhythmias, cardiogenic shock
(8) hepatic dysfunction
(9) multiple organ failure
Late clinical findings:
(1) alopecia
(2) peripheral neuropathy (polyneuritis)
Doses >= 0.1 mg/kg are associated with significant mortality.
The death rate is if very high with doses > 0.8 mg/kg.
Management:
(1) gut decontamination
(2) management of shock, DIC and multi-organ failure
(3) prevention of secondary infection
(4) anti-colchicine antibodies (if available)
(5) granulocyte colony stimulating factor (Neupogen)
