scholarly journals A Case Report on Chronic Digoxin Toxicity

2021 ◽  
Vol 36 (2) ◽  
pp. 139-144
Author(s):  
Poppy Bala ◽  
AQM Reza ◽  
M Atahar Ali ◽  
Mahmood Hasan Khan ◽  
Nighat Islam ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Circulatory System ◽  
Drug Level ◽  
Symptomatic Treatment ◽  
Therapeutic Window ◽  
Type I ◽  
Severe Toxicity ◽  
Severe Nausea ◽  
Conduction Disturbances ◽  
Electrolyte Disturbances

Digitalis glycosides are among the oldest drugs used in cardiology. Nowadays, due to the limited indications for their use (advanced heart failure, usually concomitant with atrial fibrillation), cases of toxicity induced by this class of drugs are rarely observed. Digoxin produces a positive inotropic and bathmotropic effect on the heart, but has a negative chronotropic and dromotropic effect. Cardiac glycosides have a narrow therapeutic window, so digitalis treatment can easily lead to symptoms of overdose. In patients taking digoxin, the drug therapeutic level should be maintained at 1-2 ng/ml; the toxic effects occur at concentrations > 2.8 ng/ml and are mainly related to disturbances of cardiac function and of the circulatory system, as well as gastrointestinal symptoms and CNS disturbances. Here, a 65-years-old patient who was hospitalized following chronic ingestion with acute renal impairment. In spite of rapidly applied gastric irrigation and administration of activated charcoal, the drug level in the patient’s blood was estimated at 8.5 ng/ml. During her stay on the ward, typical symptoms of severe toxicity were observed: from gastric symptoms (severe nausea, vomiting) to conduction disturbances. Type I, moitz type 1 and 2 AV blocks were detected, as well as some supraventricular extrasystoles. These conduction disorders required the use of temporary endocardial pacing. Due to the unavailability of specific antidotes (antidigitalis antibodies) and lack of efficient methods of extracorporeal elimination of the drug, symptomatic treatment comprising the correction of electrolyte disturbances and heart rate control remains the most effective. Bangladesh Heart Journal 2021; 36(2): 139-144

scholarly journals 858 TILKine-2: a novel best-in-class tumor infiltrating lymphocyte (TIL) targeting engineered IL-2 with superior pre-clinical efficacy and safety for immunotherapy of cancer

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A899-A899
Author(s):  
Sreerupa Challa ◽  
Jonathan Carnino ◽  
Andrea Umana ◽  
Yuesheng Li ◽  
Jing Xu ◽  
...  
Keyword(s):  
Nk Cells ◽  
Half Life ◽  
Intracellular Signaling ◽  
Functional Characterization ◽  
Interleukin 2 ◽  
Systemic Toxicity ◽  
Fine Tuning ◽  
Therapeutic Window ◽  
High Dose ◽  
Severe Toxicity

BackgroundHigh-dose Interleukin-2 is the earliest FDA-approved immunotherapy for metastatic melanoma and renal cell carcinoma. Unfortunately, its application is limited due to its short half-life and severe toxicity at the therapeutic dose. To limit systemic toxicity, tumor-targeting antibody-based delivery of IL-2 has been developed, however with poor outcomes. We here deploy a novel strategy to deliver IL-2 to the tumor microenvironment by binding to Tumor-Infiltrating Lymphocytes (TILs). TILKine-2 is a recombinant bifunctional protein comprised of an antibody directed against TILs (TILAb) fused to an engineered IL-2, which simultaneously revives and expands antigen-primed exhausted T cells. The IL-2 portion of TILKine-2 was engineered to have improved tolerability, slower receptor-mediated clearance, and prolonged half-life.MethodsTarget binding of TILKine-2 was evaluated by cell-free and cell-based methods. In vitro functional characterization was performed using human peripheral blood mononuclear cells (PBMCs). Pharmacokinetics (PK), pharmacodynamics (PD), and anti-tumor activity of murine TILKine-2 surrogate (TILKine-2s) were evaluated in various syngeneic models. The safety and immune cell activation of TILKine-2 were assessed in non-human primates (NHPs).ResultsStructure-based design and activity-guided fine-tuning resulted in an optimized IL-2 variant that was fused to TILAb to generate TILKine-2. TILKine-2 demonstrated TIL-target antigen binding and blocking activity with sub-nM potency. TILKine-2 has a binding activity abolished to IL-2Rα and fine-tuned to IL-2Rβγ. In PBMCs, TILKine-2 potently induced intracellular signaling and cell proliferation in IL-2Rβγ dominant effector CD8+T and NK cells along with IFN-γ secretion. In vivo, TILKine-2 displayed significantly prolonged half-life with sustained proliferation, expansion, and Granzyme B expression on CD8+T and NK cells. Notably, the effects were more pronounced in the tumor than periphery, leading to massive immune hot tumors. Consequently, TILKine-2s exhibited robust anti-tumor primary and memory response in both cold and hot tumor models (MC38, CT26, B16F10, PAN02). Furthermore, TILKine-2s demonstrated superior and synergistic anti-tumor efficacy compared to TILAb alone, engineered IL-2 alone, or their combination, with 100% tumor regression resulting in ~80% tumor free mice in MC38 and Pan02 models. In NHPs, TILKine-2 preferentially induced memory CD8+T, total CD8+T, and NK cell expansion. TILKine-2 was safe and well-tolerated in NHPs with no notable changes in body weight, temperature, clinical pathology, or signs of vascular leakage after repeated dosing.ConclusionsBy targeting TILs, TILKine-2 demonstrated robust anti-tumor efficacy by preferentially inducing proliferation, expansion, and activation of intra-tumoral lymphocytes while reducing systemic toxicity and improving therapeutic window. In conclusion, TILKine-2 is a promising therapeutic agent for clinical development.Ethics ApprovalFor mouse studies, the practices and procedures used were reviewed and approved by Brandeis University IACUC committee (Protocol #22001). For monkey studies, the practices and procedures used were in accordance with the safety and Quality Assurance guidelines set out in the Guideline for Experiments document of Kunming Biomed International (KBI--01-GEv2.0).

Applying a Low-FODMAP Dietary Intervention to a Female Ultraendurance Runner With Irritable Bowel Syndrome During a Multistage Ultramarathon

2019 ◽  
Vol 29 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Stephanie K. Gaskell ◽  
Ricardo J.S. Costa
Keyword(s):  
Irritable Bowel Syndrome ◽  
Dietary Intervention ◽  
Gastrointestinal Symptoms ◽  
Irritable Bowel Syndrome Symptom ◽  
Carbohydrate Intake ◽  
Severe Nausea ◽  
Dietary Analysis ◽  
Irritable Bowel ◽  
Fodmap Diet ◽  
The Impact

Malabsorption of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) in response to prolonged exercise may increase incidence of upper and lower gastrointestinal symptoms (GIS), which are known to impair exercise performance. This case study aimed to explore the impact of a low-FODMAP diet on exercise-associated GIS in a female ultraendurance runner diagnosed with irritable bowel syndrome, competing in a 6-day 186.7-km mountainous multistage ultramarathon (MSUM). Irritable bowel syndrome symptom severity score at diagnosis was 410 and following a low-FODMAP diet (3.9 g FODMAPs/day) it reduced to 70. The diet was applied 6 days before (i.e., lead-in diet), and maintained during (5.1 g FODMAPs/day) the MSUM. Nutrition intake was analyzed through dietary analysis software. A validated 100-mm visual analog scale quantified GIS incidence and severity. GIS were modest during the MSUM (overall mean ± SD: bloating 27 ± 5 mm and flatulence 23 ± 8 mm), except severe nausea (67 ± 14 mm) experienced throughout. Total daily energy (11.7 ± 1.6 MJ/day) intake did not meet estimated energy requirements (range: 13.9–17.9 MJ/day). Total daily protein [1.4 ± 0.3 g·kg body weight (BW)−1·day−1], carbohydrate (9.1 ± 1.3 g·kg BW−1·day−1), fat (1.1 ± 0.2 g·kg BW−1·day−1), and water (78.7 ± 6.4 ml·kg BW−1·day−1) intakes satisfied current consensus guidelines, except for carbohydrates. Carbohydrate intake during running failed to meet recommendations (43 ± 9 g/hr). The runner successfully implemented a low-FODMAP diet and completed the MSUM with minimal GIS. However, suboptimal energy and carbohydrate intake occurred, potentially exacerbated by nausea associated with running at altitude.

scholarly journals Retrospective analysis of clinical characteristics of 405 patients with COVID-19

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094903 ◽  
Author(s):  
Ting Zhan ◽  
Meng Liu ◽  
Yalin Tang ◽  
Zheng Han ◽  
Xueting Cheng ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Circulatory System ◽  
Respiratory Illnesses ◽  
Reactive Protein ◽  
Circulatory System Diseases ◽  
History Of ◽  
Abnormal Lymphocyte

Objective This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan. Results The patients’ median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels. Conclusion SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.

Analysis of hydration and antiemetics policies in preventing cisplatin-related gastrointestinal and renal toxicities in low-risk human papillomavirus positive-oropharyngeal cancer (HPV+OPC) patients undergoing chemoradiation in De-ESCALaTE trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6076-6076
Author(s):  
Anthony Hee Kong ◽  
Pankaj Mistry ◽  
Mererid Evans ◽  
Andrew G. J. Hartley ◽  
Tessa Fulton-Lieuw ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Oropharyngeal Cancer ◽  
Low Risk ◽  
Secondary Outcome ◽  
Severe Toxicity ◽  
Severe Nausea ◽  
Serious Adverse Events ◽  
Antiemetic Regimen ◽  
Oral Fluids ◽  
Adequate Hydration

6076 Background: The De-ESCALaTE trial confirmed the superiority of cisplatin over cetuximab in combination with radiotherapy for the treatment of low risk human papillomavirus positive oropharyngeal cancer (HPV+OPC). The most common serious adverse events (SAEs) for cisplatin were due to vomiting and nausea, in contrast with oral mucositis and vomiting for concurrent cetuximab. In this study, we examined the efficacy of different hydration and anti-emetic policies in preventing cisplatin-related gastrointestinal and renal toxicities as well as related SAEs in the cisplatin arm of the De-ESCALaTE trial. Methods: This was a post-hoc pre-specified analysis of data collected within the De-ESCALaTE trial including pre-hydration, diuretics, the amount of intravenous (IV) fluids before, during and after chemotherapy, whether oral fluid hydration was advised and type of antiemetic regimen prescribed, if any, after chemotherapy administration, including if a triple antiemetic regimen with a NK1 receptor antagonist, steroids and a serotonin 5-HT3 antagonist was given before and after chemotherapy. The primary outcome was number of SAEs per patient; secondary outcome was number per patient of cisplatin-induced severe toxicity events of interest: nausea, vomiting, dehydration or renal toxicity. Results: 166 (mean age 57 yrs; 132 m, 34 f) patients received cisplatin. Hydration and anti-emetics policies for cisplatin treatment are significantly correlated with the rate of SAEs and acute severe nausea, vomiting, dehydration or renal toxicities. Using stepwise backwards multivariable ordinal logistic regression in the presence of baseline characteristics, use of a triple anti-emetics regimen (OR 0.41,p = 0.032) and 2.5 to 3L IV fluids given before and during cisplatin chemotherapy (OR 0.161, p = 0.009) as well as oral fluids advised post chemotherapy (OR 0.365, p = 0.03) were associated with a significantly lower incidence of SAEs and severe toxicities of interest. We will also present data on relative cost-effectiveness of the different regimens. Conclusions: Based on our results, we recommend the use of a triple anti-emetic regimen, adequate hydration of 2.5-3L before and during chemotherapy as well as advising patients to take oral fluids advised to reduce cisplatin toxicities related to nausea, vomiting, dehydration and/or renal injury. Clinical trial information: ISRCTN33522080.

scholarly journals Gastrointestinal symptoms of migraine in children and adolescents

2020 ◽  
pp. 112-118
Author(s):  
O. V. Serousova ◽  
M. I. Karpova ◽  
A. I. Dolgushina ◽  
D. B. Kulikova
Keyword(s):  
Abdominal Pain ◽  
Children And Adolescents ◽  
Migraine Attack ◽  
Early Onset ◽  
Negative Relationship ◽  
Gastrointestinal Symptoms ◽  
Episodic Migraine ◽  
Nausea And Vomiting ◽  
Severe Nausea ◽  
Male Patients

Objective: to study the characteristics, frequency of occurrence, and clinical signifi cance of nausea, vomiting, abdominal pain associated with a migraine attack, in children and adolescents.Materials and methods. Included 32 patients aged 7 years to 18 years with a diagnosis of episodic migraine. All patients were carefully analyzed for nausea, vomiting, and abdominal pain accompanying a migraine attack.Results. Nausea bothered 78% of patients, the median of its intensity corresponded to pronounced. Vomiting accompanied attacks in 68%, the median of its quantity—3 per day. Attack pain in the abdomen developed in 6% of patients. Moreover, the early onset of migraine seizures is associated with severe nausea and vomiting (p = 0,015 and p = 0,043, respectively). Among male patients, direct correlations were obtained between headache intensity and nausea intensity (rS = 0,456, p = 0,029, n = 23) and the amount of vomiting (rS = 0,417, p = 0,048, n = 23).Conclusion.1. With migraine in children and adolescents, nausea and vomiting are often seen as symptoms associated with an attack, while abdominal pain is a rare manifestation of a migraine attack.2. There is a negative relationship between the age of the patient and the intensity of vomiting, the early onset of migraine attacks is often associated with severe nausea and vomiting, and in male patients, the intensity of the headache directly correlates with the intensity of nausea and the amount of vomiting.3. There was no dependence of gastrointestinal manifestations on the patient’s gender, the presence of an aura during an attack, the frequency of attacks and the number of pain days. 

scholarly journals Tumor-Specific Catalysis-Mediated Enhanced Chemodynamic Therapy in Synergy with Mitophagy Inhibition Improves Therapeutic Efficacy in Endometrial Cancer

2021 ◽  
Author(s):  
Xiaodi Gong ◽  
Jing Wang ◽  
Linlin Yang ◽  
Lijuan Li ◽  
Xiao Sun ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Therapeutic Modality ◽  
Therapeutic Window ◽  
Tumor Growth Inhibition ◽  
Target Cells ◽  
Type I ◽  
Dna Double Strand Breaks ◽  
Quinone Oxidoreductase ◽  
Positive Target ◽  
Arginine Glycine Aspartic Acid

Abstract BackgroundChemodynamic therapy (CDT) relies on tumor microenvironment (e.g. high H2O2 level) responsive Fenton-like reactions to produce hydroxyl radicals (·OH) against tumors. However, endogenous H2O2 is insufficient for effective chemodynamic reactions.ResultsAn NAD(P)H: quinone oxidoreductase 1 (NQO1)highCatalase (CAT)low therapeutic window for the use of NQO1 bioactive drug β-lapachone (β-Lap) was firstly identified in endometrial cancer (EC). Accompanied by NADH depletion, β-Lap was catalyzed by NQO1 to produce excess H2O2 initiating oxidative stress, which selectively suppressed NQO1high EC cell proliferation, induced DNA double-strand breaks and promoted apoptosis. SiRNA-mediated NQO1 knockdown or dicoumarol rescued NQO1high EC cells from β-Lap-induced cytotoxicity. Arginine-glycine-aspartic acid (RGD)-functionalized iron-based metal organic frameworks-MOF(Fe) further promoted the conversion of accumulated H2O2 into highly oxidative ·OH, and in turn exacerbated the oxidative damage to RGD-positive target cells. Mitophagy inhibition by Mdivi-1 blocked a powerful antioxidant defense approach, ultimately ensuring the antitumor efficacy of stepwise amplified ROS signals. The tumor growth inhibition rate was about 85.92%.ConclusionsTumor specific chemotherapy in combination with CDT-triggered therapeutic modality presented unprecedented therapeutic advantages for the treatment of NQO1+ advanced type I or type II EC.

scholarly journals Therapeutic effects of combined meloxicam and glucosamine sulfate treatment on patients with osteoarthritis, and its effect on serum CTX-Ⅰ, CTX-Ⅱ, COMP and MMP-3

2021 ◽  
Vol 18 (7) ◽  
pp. 1553-1557
Author(s):  
Lu Zhijun ◽  
Chen Rongchun ◽  
Lin Feixiang ◽  
Wu Yaohong ◽  
Liu Ning ◽  
...  
Keyword(s):  
Treatment Group ◽  
Matrix Protein ◽  
Type I Collagen ◽  
Clinical Symptoms ◽  
Type Ii Collagen ◽  
Symptomatic Treatment ◽  
Glucosamine Sulfate ◽  
Control Group ◽  
Therapeutic Effects ◽  
Type I

Purpose: To study the therapeutic influence of meloxicam-glucosamine sulfate combination in patients with osteoarthritis and their effect on serum CTX-I, CTX-II, COMP and MMP-3. Methods: A total of 88 patients with osteoarthritis were assigned to control (n = 44) and treatment groups (n = 44), using the random number table method. Control group was given 7.5 mg of meloxicam, while treatment group received 0.5 g of glucosamine sulfate capsule in addition to meloxicam. Both groups were treated continuously for 8 weeks. Serum levels of C-terminal telopeptide of type I collagen (CTX-I), C-terminal telopeptide of type II collagen (CTX-II), cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase-3 (MMP-3) were compared for the two groups after treatment. Results: Lysholm score significantly increased in the two groups after treatment. Serum CTX-I, CTX-II, COMP and MMP-3 in the two groups were significantly lower than before treatment, but the reductions were more pronounced in the treatment group (p < 0.05). During treatment, mild vomiting and pruritus of the skin appeared in both groups, but these were relieved after symptomatic treatment without any serious adverse reactions. Conclusion: Treatment with a combination of meloxicam and glucosamine sulfate produces significant beneficial effects in patients with osteoarthritis by reduction of clinical symptoms, pain relief and reduction of serum CTX-I, CTX-II, MMP-3 and COMP.

scholarly journals Clinical and Hematological Follow-Up of Long-Term Oral Therapy with Type-I Interferon in Cats Naturally Infected with Feline Leukemia Virus or Feline Immunodeficiency Virus

Animals ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 1464
Author(s):  
Esperanza Gomez-Lucia ◽  
Victorio M. Collado ◽  
Guadalupe Miró ◽  
Sonsoles Martín ◽  
Laura Benítez ◽  
...  
Keyword(s):  
Feline Immunodeficiency Virus ◽  
Leukemia Virus ◽  
Clinical Status ◽  
Symptomatic Treatment ◽  
Feline Leukemia Virus ◽  
Human Interferon ◽  
Interferon Α ◽  
Type I ◽  
End Of Treatment ◽  
Immunodeficiency Virus

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV), two of the most important pathogens of cats, produce chronic systemic diseases with progressive death of cells involved in the immune response, ultimately leading to death. Immunostimulants is one of the few alternatives to the symptomatic treatment. In this study, 27 naturally FeLV-infected (FeLV+) and 31 naturally FIV-infected (FIV+) cats were administered orally by their owners 60 IU/day of recombinant human interferon alpha (rHuIFN-α) for four months in alternate weeks. Clinical status was evaluated and blood samples collected at four different visits or months (M): pretreatment (M0), mid-treatment (M2), end of treatment (M4), and 4–8 months after end of treatment (M10). Most cats ostensibly improved their clinical status, and many became asymptomatic. rHuIFN-α treatment improved the anemic processes observed at M0 (at least in cats with mild or moderate anemia) and leukocyte counts, including a more favorable CD4+/CD8+ ratio. An increase in the serum gammaglobulin concentration was seen in 80% of the cats. Despite observing an obvious favorable progress in the clinical, biopathological, and CD4+/CD8+ values during treatment, almost invariably all the parameters analyzed worsened after treatment discontinuation (M10), which suggests that the interferon-α protocol should be either extended or include additional cycles for a long-lasting benefit in FeLV+ and FIV+ cats.

HEART RATE AND CONDUCTIVITY DISORDERS FEATURES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND RECURRENT ISCHEMIA

2021 ◽  
pp. 58-65
Author(s):  
Balabanov A.S. ◽  
Epifanov S.Yu. ◽  
Reiza V.A.
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Study Group ◽  
Type I ◽  
Conduction Disturbances ◽  
Recurrent Myocardial Infarction ◽  
Group I

Relevance. Heart arrhythmia in early postinfarction angina and recurrent myocardial infarction is negatively affected the prognosis of the disease. Aim. To evaluate the peculiarities of heart rhythm and conduction disturbances and electrocardiographic (ECG) changes in men under 60 years old with early postinfarction angina and recurrent myocardial infarction for improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with myocardial infarction type I. Patients were divided into two age-comparable groups: I - study group with recurrent episodes of ischemia (early postinfarction angina pectoris and / or recurrent MI) - 110 patients; II - control, without them - 555 patients. A comparative assessment of heart arrhythmias and electrocardiographic changes observation frequency in the selected groups was performed. Results. In the patients of the study group more often than among all other patients, ventricular fibrillation was observed (8.5 and 3.9%, respectively; p = 0.04), paroxysmal supraventricular tachycardia (5.7 and 1.8%; p = 0.02) and electrocardiographic signs of the right atrium enlargement (9.4 and 1.6%; p ˂ 0.0001). In group I, among the deceased, electrocardiographic signs of left ventricular hypertrophy were more often detected (93.3 and 57.9%; p = 0.02). Arrhythmias that started in the subacute period of myocardial infarction were recorded with the same frequency in both groups of patients (1.4 and 1.6%; p = 0.9). Conclusions. Men under 60 years old with recurrent episodes of ischemia in myocardial infarction are characterized by potentially curable ventricular fibrillation and supraventricular tachycardias. Electrocardiographic signs of left ventricular enlargement were an additional marker of a poor prognosis for these patients. The frequency of occurrence of "late" arrhythmias in this pathology is 1.4%, and the methods of their possible correction require clarification depending on the mechanism of their development.

scholarly journals Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs

CJEM ◽  
2014 ◽  
Vol 16 (03) ◽  
pp. 252-256 ◽  
Author(s):  
Anjuli Little ◽  
David Tung ◽  
Christine Truong ◽  
Stephen Lapinsky ◽  
Lisa Burry
Keyword(s):  
Multiorgan Failure ◽  
Treatment Options ◽  
Therapeutic Index ◽  
Antiinflammatory Drug ◽  
Nonsteroidal Antiinflammatory Drug ◽  
Toxic Effects ◽  
Severe Toxicity ◽  
Antiinflammatory Drugs ◽  
Volume Depletion ◽  
Severe Nausea

ABSTRACT Colchicine has a low therapeutic index. Its toxic effects generally occur at doses ≥ 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited.

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