Attending Physician RUSH University Medical Center
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Introduction: Colchicine toxicity is rare but has high mortality. Once ingested there is a small window to decontaminate the GI tract after which there is no antidote. While there have been a few reported cases of using ECMO for support in colchicine toxicity, optimal timing and appropriate patient selection is unknown.
Description: A 31-year-old female with Still’s disease presented with abdominal pain. Her initial labs were normal. Later she admitted to intentional ingestion of 80 tablets of 0.6 mg colchicine. She refused activated charcoal at first but was convinced to take 50 grams 16 hours after initial presentation. Soon after admission she developed significant metabolic acidosis with pH 7.237 and bicarbonate of 15, elevated lactic acid of 9.9, acute kidney injury and acute liver failure. She was intubated and started on continuous renal replacement therapy. She had escalating vasopressor requirements. ECMO was discussed with cardiovascular surgery, but she was not deemed a candidate given her multiorgan, specifically liver, failure. She suffered PEA arrest and resuscitation efforts were stopped per family request.
Discussion: Colchicine works by binding to tubulin which then interferes with the building of microtubules and causes cell dysfunction. Initially it causes leukocytosis and gastrointestinal symptoms. Later there is progression to bone marrow suppression causing pancytopenia, rhabdomyolysis, renal failure, metabolic acidosis, respiratory failure, ARDS, and cardiac dysrhythmia. There have been few cases reports of ECMO being utilized for colchicine toxicity with variable results. Once case published in 2013 showed success in a 52 year old male who had ingested 17 mg. However, a second case in 2024 of a 29 year old male with ingestion of both colchicine and carvedilol resulted in death despite extracorporeal life support. Our case once again brought up the question of when and in whom to offer ECMO. Given the extremely high rates of morbidity it is of utmost importance to recognize early and attempt GI decontamination with activated charcoal and even whole bowel irrigation. Ideally charcoal should be given within 30 minutes. In our case, the patient unfortunately presented several hours after ingestion so interventions were unlikely to change the ultimate outcome.
