Problems for Discussion - 2 - Colchicine (and colchicine-containing plants)

1. Why can’t toxicologists agree?
2. Review the HyperTox monograph and Baud (1995).

1. Having read Baud’s paper, consider that if you had colchicine antibodies would you use them?
2. Speculate on what factors make digoxin antibodies available when colchicine antibodies are not.

A 45 year old female presented 1 hour after ingestion of a single tuber of Gloriosa superba. She appeared well.

1. What is your initial management
2. She refuses all interventions.
3. How would you proceed?

A 40 year old male presented 5 hours following ingestion of a long tuber of Gloriosa superba . He appeared unwell with profuse vomiting and blood stained diarrhoea.
His pulse was 110 beats per minute and the blood pressure was 70/60mmHg. The arterial blood gas analysis revealed a pH of 7.1, HCO3 of 12mmol/L, CO2 of 13mmHg and a base excess of -5. Total WBC of 32000/mm3 with 90% neutrophils.

1. What is your risk assessment
2. Propose a mechanism for these clinical features
3. What is your management

72 hours afterwards his urine output was 10ml/hour and the FBC revealed: Hb 5g/dL, WBC 1500/mm3 and platelets 10000/mm3.

1. What has happened?
2. What further investigations would you request?
3. What is your management?