Case Definition: Colchicine

Clinical description

Ingestion of colchicine typically leads to profuse vomiting and diarrhea, which can be bloody, followed by hypovolemic shock and multisystem organ failure within 24-72 hours. Coma, convulsions, and sudden death might also occur. Subsequent complications include bone marrow suppression with resultant leukopenia, thrombocytopenia (nadir in 4-7 days), and possibly sepsis (1).

Laboratory criteria for diagnosis

• Biologic: A case in which colchicine is detected in urine, serum, or plasma (2), as determined by a laboratory.

- OR-

• Environmental: Detection of colchicine in environmental samples.

Case classification

• Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
• Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for colchicine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
• Confirmed: A clinically compatible case in which laboratory tests have confirmed exposure.

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.

Additional resources

1. Milne ST, Meek PD. Fatal colchicine overdose: report of a case and review of the literature. Am J Emerg Med 1998;16:603--8.
2. Tracqui A, Kintz P, Ludes B, Rouge C, Douibi H, Mangin P. High-performance liquid chromatography coupled to ion spray spectrometry for the determination of colchicine at ppb levels in human biofluids. Chromatogr B: Biomed Sci Appl, 1996;675:235-42.
3. Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Nguyen P, Dubnov-Raz G, Pollak U, Koren G, Bentur Y. Colchicine poisoning: the dark side of an ancient drug. Clin Toxicol (Phila). 2010 Jun;48(5):407-14.
4. Ko, RJ, Li WY, Koda, RT (1990). Determination of the antimitotic agents N-Desacetylcolchicine, demecocline and colchicine in serum and urine. J Chromatogr B: Biomed Sci Appl 525:411-418.
5. Hoja, H, Marquet, P, Verneuil B, Lifti H, Dupuy JL, Dreyfuss, MF, Lachatre G (1996). Determination of colchicine in biological fluids by liquid chromatography mass spectrometry with pneumatically assisted electrospray ionization. Analysis 24(9-10): 391-394.