Correct!
2. Colchicine
The patient’s father took colchicine and the entire case began with her eating “bad tasting” chicken. Colchicine toxicity occurs in 3 stages (Table 2) (3).
Table 2. Phases of colchicine toxicity.
Our patient’s colchicine level was 7.2 ng/ml several days after presentation. Colchicine is a poison of the microtubules which are involved in a variety of cellular movements and cell division which explains its diffuse toxic effects.
Opiate toxicity results in respiratory depression. Acetaminophen/hydrocodone overdosage could result in respiratory depression from the hydrocodone and progressive liver toxicity from the acetaminophen. Organophosphate poisoning is usually associated with cholinergic syndrome. Neuromuscular signs such as tremulousness, dystonia, hyperreflexia, and ataxia are usually prominent in acute lithium toxicity.
Our patient was supported with granulocyte colony stimulating factor which was ineffective in raising the white blood cell count. She developed progressive shock, abdominal compartment syndrome, and her lactate rose to 16 mmol/L. She died 9 days after transfer. The source of the colchicine poisoning remains unclear. It could have been self-induced or a homicide attempt.
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