A new approach for early onset cardiogenic shock in acute colchicine overdose: place of early extracorporeal life support (ECLS)?

Abstract

Dear Editor, Colchicine belongs to the family of spindle poisons, which are mainly used to treat and prevent forms of microcrystalline arthritis, such as gout. It has a narrow therapeutic index. Colchicine overdose is associated with a high mortality rate [1]. Early symptoms usually include gastrointestinal pain; multiorgan failure typically occurs next, alongside metabolic derangements and bone marrow suppression. Prognostic factors include a supposed ingested dose of [0.8 mg/kg, cardiogenic shock, and ARDS [1]. Death from acute colchicine poisoning is usually due to hemodynamic collapse and cardiac arrhythmias. A 51-year-old male pharmacist (medical history of depression, high blood pressure, and gout treated with colchicine) was admitted to the ICU for an acute and unexplained circulatory shock. Over the course of his admission he continued to deteriorate and required high doses of norepinephrine (4.2 lg/kg/min), epinephrine (0.4 lg/kg/min), and dobutamine (10 lg/kg/min). After the first 24 h, his wife found a bottle of 1 mg Colchimax (17 tablets missing). The patient then admitted to ingesting those tablets, which was later confirmed by laboratory investigations: 9.7 nmol/L at day 1; 9.25 nmol/L at day 3; 5.75 nmol/L at day 6; and less than 1.25 nmol/L at day 16. Following the confirmation of a colchicine overdose, the patient’s clinical condition worsened. He quickly developed multiorgan failure and was hemodynamically unstable. In the ICU, it was decided to resort to a bedside-to-bench process. For the following 10 days he received extracorporeal life support (ECLS) (CARDIOHELP, Maquet, Rastatt, Germany), which was achieved through femoral venous arterial cannulation surgery with an initial rate of 3 L/min, 3,700 rev/min. He made a good recovery and showed normal organ function by day 6. The ECLS was removed on day 10 and the mechanical ventilator on day 20. He did not present any hematological failure. He suffered from an acute renal failure due to tubular necrosis that required dialysis for 36 days. The patient was discharged on day 52 with a CPC score of 1. Recent studies have proved that human [1] and animal [2] immunotherapy antibodies can be successfully used to treat colchicine overdose. However, there are a few limitations on the use of immunotherapy antibodies: