I don't know if you have seen "Six Groups of Serious Cases", which was all the rage in that year, setting a record for the highest ratings of the police and bandit theme. Recently, I was bored and revisited, but I inadvertently found an important knowledge point, which is very similar to the cases I have encountered in the clinic.
Source: TV series "Six Groups of Serious Cases"
This is the plot of the first episode 18, which mentions QS-J poisoning, which has symptoms like viral diarrhea, abdominal pain and diarrhea. So what exactly is QS-J? In fact, QS-J is our commonly used colchicine in clinical practice.
What is Colchicine?
The clinical use of colchicine has a history of hundreds of years, and the main indications are acute gout and familial Mediterranean fever.
Guidelines recommend that small doses be used in the treatment of acute attacks of gout "0.5 to 1.0 mg/day, adjusted according to renal function". Maintenance therapy with low-dose colchicine can also be used as a first-line recommendation (1A) for preventing gout attacks.
Colchicine alters cell membrane function by binding to subunits of neutrophil tubulin, including inhibiting chemotaxis, adhesion, and phagocytosis of neutrophils;
Inhibits phospholipase A2, reduces the release of prostaglandins and leukotrienes by monocytes and neutrophils, and inhibits local cells from producing interleukin-6, thereby controlling local pain, swelling and inflammatory responses in joints.
Why does colchicine become a murderous poison?
In fact, colchicine itself is less toxic, but it will be metabolized into dicopontine with strong toxicity in the body, which has a strong stimulating effect on the digestive tract, hematopoietic system, central nervous system, etc.
The instructions pointed out that colchicine is a cellular mitosis toxin, which is toxic, and once the overdose lacks rescue measures, special attention must be paid to drug overdose.
Our department has treated two colchicine poisoning patients.
Case 1: Male, 21 years old, vomiting, diarrhea and watery stools after taking 91 tablets of colchicine after emotional agitation, accompanied by paroxysmal abdominal cramps, poison analysis is 305 ug/L of colchicine component in the blood (poisoning amount > 50 ug/L), admitted to hospital.
Case 2: Male, 40 years old, admitted to hospital for half a day with fever due to diarrhea and 2 days of elevated creatinine. The patient developed diarrhea, yellow watery stools, accompanied by fever, up to 39°C, and was treated with rehydration solution and etimicin for 1 day after 2 days of admission, and the symptoms did not improve, and they were admitted to the hospital for further diagnosis and treatment. After asking about the medical history, the patient's history of gout, recently increased the amount of colchicine "specific unknown", and the toxic analysis after admission showed that the colchicine component in the blood was 67.5 ug/L "the amount of poisoning > 50 ug/L".
In both cases, CRRT "hemoperfusion + hemofiltration" was performed after admission, but in the end, both died of ineffective rescue.
Rare but deadly, more vigilant
Clinically, colchicine poisoning is uncommon, and the literature is mostly reported on a case-by-case basis.
It is generally believed that colchicine doses of 0.5 to 0.8 mg/kg are toxic to the body, and doses higher than 0.8 mg/kg can be fatal; however, there are cases of death after ingestion of 0.4 mg/kg colchicine for 35 h.
The clinical manifestations and prognosis of colchicine poisoning are correlated with the dose of the drug ingested and are usually manifested as:
The first stage of "10 to 24 hours" early gastrointestinal symptoms, hypovolemia, leukocytosis;
The second stage is "2 to 7 days" of abnormal delirium, renal failure, rhabdomyolysis, hematopoietic inhibition, acid-base imbalance, arrhythmia. Patients usually die in the second stage.
The third stage is "after 7 days" of hair loss, white blood cell rebound, electrolyte metabolism disorders.
Note: There is no clear demarcation between these three stages and there may be overlap.
For the treatment of colchicine poisoning, blood purification is still the mainstay. Because colchicine is absorbed through the gastrointestinal tract and widely distributed in the body, the apparent distribution volume is large, and the plasma protein binding rate is low, hemodialysis or hemoperfusion is basically ineffective. Plasmapheresis efficacy is also uncertain. In vitro experiments have shown that activated carbon has a strong scavenging effect on colchicine.
For drug therapy, there are currently no effective antidotes. Colchicine-specific Fab fragments may be a promising detoxification drug in the future, but it is still in the experimental stage.
In general, the mortality rate of colchicine poisoning is extremely high, and there are currently no definitive and effective treatment and rescue measures, and clinical prevention should still be the mainstay. For patients taking colchicine, doctors must emphasize the safety of medication to patients, and must not increase the amount of medicine without authorization, and do not let life-saving drugs become life-saving drugs.
Typography | Qi Min Dai Dongjun
Caption | Stand cool Heero
Special note: The above content is for medical and health professionals to refer to and learn only