colchicum autumnale , commonly known as the autumn crocus , wild saffron and naked lady , contains alkaloid colchicine that is antimitotic , blocking the mitosis by preventing dna synthesis and tubulin polymerization . the clinical manifestations of colchicine poisoning are present in three phases following a latent period of 412 hours . the first phase is characterized by peripheral leukocytosis , gastrointestinal symptoms with fluid losses and hypovolemic shock . during 2472 hours , the second stage of intoxication , life - threatening complications occur such as heart failure , arrhythmias , renal failure , hepatic injury , respiratory distress , coagulopathies , bone marrow depression and neuromuscular involvement . this second phase can last for 57 days and is followed by the third phase , characterized by leukocytosis and alopecia . when ingested , colchicine is rapidly absorbed from the gastrointestinal tract and is primarily metabolized by the liver in a first - order process . renal excretion is responsible for only about 20% of unchanged colchicine elimination , although this fraction may be increased in the presence of liver disease . colchicine is used in the management of acute gouty arthritis , and a suicidal colchicine tablet overdose is the most common cause of colchicine poisoning . searching medline we found only four case reports of accidental poisoning with colchicum autumnale , and in none of them were blood colchicine concentrations measured [ 10 - 12 ] . in spring 2003 , a 76-year - old man ate two whole plants regarded as wild garlic ( aliium ursinum ) . he also had a history of chronic renal insufficiency and arterial hypertension , which he treated with verapamil and trandalopril . he brought with him the remaining plant that he had not yet eaten ( fig . the patient was treated with gastric lavage and 30 g oral activated charcoal and was transferred to the intensive care unit . on arrival at the intensive care unit , the patient complained of diarrhea and abdominal pain . his vital signs were a glasgow coma scale of 15 , a tympanic temperature of 37.1c , a respiratory rate of 22 counts / min , a pulse of 122 counts / min and a blood pressure of 125/80 mmhg in the supine position . the electrocardiogram showed a sinus tachycardia , and the chest x - ray was normal . abdominal ultrasound revealed hepatic steatosis . during day 1 the patient had only gastrointestinal symptoms and was treated with 3000 ml normal saline and repeated doses of activated charcoal . the electrocardiogram showed only diffuse nonspecific st changes , yet with positive troponin i values indicating myocardial necrosis ( table 1 ) . on day 3 the patient developed a high - grade fever and became hypotensive and anuric despite hydration and noradrenaline infusion . abdominal peristaltic sound could not be detected and abdominal x - ray showed a dilated intestine . laboratory tests also revealed rhabdomyolysis , coagulopathy and deterioration of metabolic acidosis , renal function and hepatic function ( table 1 ) . profuse bleeding from the nose appeared and fresh frozen plasma and platelets were given . at the end of day 3 subsequent toxicology analysis by gas chromatography coupled to mass spectrometry showed colchicine in the patient gastric lavage , urine and serum samples , which were stored in light - protected containers ( table 1 ) . an autopsy showed a dilatated heart with a transversal diameter of the left ventricle of around 65 mm , pulmonary edema , bilateral bronchopneumonia , liver and kidney necrosis , hypocellular bone marrow with diserythopoiesis , dismyeloiesis and dismegacaryopoiesis . the presented patient mistakenly ingested autumn crocus instead of wild garlic , whose leaves are used as a spice or medical plant . autumn crocus and wild garlic are quite similar , especially their leaves , and unfortunately they grow in the same areas at the same time the remaining plant that the patient brought to the emergency department weighed around 5 g. the colchicine content of autumn crocus is 0.10.6% . the total colchicine dose ingested by the patient could be calculated as follows : 2 ( plants )  5 g ( weight of the plant )  0.10.6% ( content of colchicine in the plant)/73 kg ( patient 's weight ) . the estimated colchicine dose ingested by the patient was between 0.14 mg / kg ( 10 mg ) and 0.82 mg / kg ( 60 mg ) . according to published data , gastrointestinal symptoms are usually observed at doses less than 0.5 mg / kg and doses greater than 0.8 mg / kg are almost invariably fatal . everything from mild gastroenterocolitis to multiorgan failure followed by death could therefore be expected in our patient . serum colchicine levels were three to six times more than the upper therapeutic level on the second and third days . we can only speculate about the highest colchicine concentration because the colchicine blood half - life is very unpredictable , reported to be between 20 min   and 19 hours . we can assume that the colchicine elimination and the blood half - life in our patient were prolonged because the patient had alcoholic liver disease , which reduces the hepatic colchicine metabolism and excretion through the bile system . the patient 's liver function was further worsened by colchicine poisoning and later by the evolving shock . an excretion of colchicine could be reduced by verapamil , which is an inhibitor of p - glycoprotein , a protein responsible for colchicine transport from the hepatocyte into bile . a compensatory increase of colchicine excretion through the kidneys the compensatory excretion was not possible since the patient 's chronic renal insufficiency was additionally deteriorated by hypotension , hypoxia and rhabdomyolysis due to the colchicine effect on muscle cells . the higher colchicine concentration on the third day compared with on the second day observed in our patient corresponds to the two - compartment model of colchicine kinetic coupled with impaired elimination in the second phase , mainly due to liver and renal insufficiency . dehydration in combination with impaired cardiac function resulted in tissue hypoperfusion with lactic acid metabolic acidosis . acute heart failure was probably the result of a direct toxic effect of colchicine on myocardial cells . specific therapy such as colchicine antibodies is reported in some case reports as well as in animal studies but it is not yet commercially available . a more severe clinical presentation should expected in patients with pre - existing liver and renal diseases . the main reasons for death are cardiovascular collapse , respiratory failure and leukopenia with infection . hepatic and renal dysfunction as well as certain drugs could worsen the prognosis of poisoning with colchicine . in patients with gastroenterocolitis after a wild plants meal , especially when wild garlic is mentioned , we should always consider poisoning with autumn crocus  prognosis of colchicine poisoning is worse in patients with pre - existing liver and renal diseases ast , aspartate aminotransferase ; alt , alanine aminotransferase ; ldh , lactate dehydrogenase ; ck , creatine kinase . laboratory data after colchicum autumnale ingestion ast , aspartate aminotransferase ; alt , alanine aminotransferase ; ldh , lactate dehydrogenase ; ck , creatine kinase .
introductioncolchicum autumnale , commonly known as the autumn crocus , contains alkaloid colchicine with antimitotic properties.case reporta 76-year - old man with a history of alcoholic liver disease and renal insufficiency , who mistakenly ingested colchicum autumnale instead of wild garlic ( aliium ursinum ) , presented with nausea , vomiting and diarrhea 12 hours after ingestion . on admission the patient had laboratory signs of dehydration . on the second day the patient became somnolent and developed respiratory insufficiency . 
 the echocardiogram showed heart dilatation with diffuse hypokinesia with positive troponin i. the respiratory insufficiency was further deteriorated by pneumonia , confirmed by chest x - ray and later on by autopsy . 
 laboratory tests also revealed rhabdomyolysis , coagulopathy and deterioration of renal function and hepatic function . 
 the toxicological analysis disclosed colchicine in the patient 's urine ( 6 g / l ) and serum ( 9 g / l ) on the second day . 
 therapy was supportive with hydration , vasopressors , mechanical ventilation and antibiotics . on the third day the patient died due to asystolic cardiac arrest.discussion and conclusioncolchicine poisoning should be considered in patients with gastroenterocolitis after a meal of wild plants . 
 management includes only intensive support therapy . 
 a more severe clinical presentation should be expected in patients with pre - existing liver and renal diseases . 
 the main reasons for death are cardiovascular collapse , respiratory failure and leukopenia with infection .