Accidental poisoning with autumn crocus (Colchicum autumnale): a case series. (3rd June 2021)

• Record Type: Journal Article
• Authors: Razinger, Gasper; Kozelj, Gordana; Gorjup, Vojka; Grenc, Damjan; Brvar, Miran
• Is Part Of: Clinical toxicology. Volume 59:Number 6(2021)
• Page Start: 493
• Page End: 499
• Publication Date: 2021-06-03
• Subjects: Colchicum autumnale -- autumn crocus -- wild garlic -- troponin -- prognostic parameter; Toxicology -- Periodicals; Toxicological emergencies -- Periodicals; 615.9
• DOI: 10.1080/15563650.2020.1832234
• Languages: English
• ISSNs: 1556-3650

Abstract

Abstract: Introduction: Colchicum autumnale (autumn crocus) is a plant that contains highly toxic alkaloid colchicine. The aim was to evaluate accidental C autumnale poisoning and assess serum troponin as a prognostic parameter. Methods: In this study, we retrospectively included all adult patients with a history of accidental C autumnale ingestion and serum colchicine confirmation during the study period from 2000 to 2019. The medical files of enrolled patients were reviewed. Literature search of accidental ingestions of C autumnale was done. Results: Over the study period of 20 years, 16 adult patients were admitted to the University Medical Centre Ljubljana due to acute colchicine poisoning after ingestion of C autumnale . They all mistakenly ingested C autumnale 's leaves instead of Allium ursinum in the spring and had confirmed colchicine in serum by GC–MS or LC–MS/MS (15.5 µg/L (0.5–80 µg/L)). They developed vomiting and diarrhoea within 1–9 h after the meal. Vomiting within 2 h was associated with lethality ( p =.04). Bone marrow suppression developed in 15 patients (94%). Acute myocardial injury with positive troponin I (>0.10 µg/L) developed in five patients; lethal cardiogenic shock with decreased cardiac output and hypotension occurred in four of these patients despite supportive therapy. Positive troponin I ultra (>0.10 µg/L) was associated with need for intensive support therapy ( p =.01), decreased cardiac output ( p =.01) and death ( p =.01). The mortality was 4/16 (25%). On review, we found 58 cases; 95% cases accidently ingested leaves of C autumnale instead of A ursinum. Troponin I was reported in 3% cases. The lethality of this and reviewed cases was 35% (26/74). Conclusions: In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice in the spring, especially when wild garlic is mentioned, we should always consider C autumnale poisoning. Cardiogenic shock can be predicted by a positive serum troponin I measurement.