Markedly altered colchicine kinetics in a fatal intoxication: Examination of contributing factors
Markedly altered colchicine kinetics in a fatal intoxication: Examination of contributing factors
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DOI：
10.1177/096032719601501104
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发表时间：
1996-11-01
影响因子：
2.8
通讯作者：
Baud, FJ
中科院分区：
文献类型：
--
作者：
Borron, SW;Scherrmann, JM;Baud, FJ
1 .秋水仙碱中毒相对罕见，但发病率和死亡率较高。虽然以秋水仙碱特异性Fab片段的形式出现了一种新的治疗方式，但目前可用的治疗方法在很大程度上是支持性的秋水仙碱的消除主要通过肝脏代谢发生，遵循一级过程，具有显著的肠肝循环。肾提取约占秋水仙碱消除量的20%我们报告一例秋水仙碱中毒，并发共摄入，血清秋水仙碱浓度在患者存活的3天内保持准恒定，与代谢和排泄的显著变化一致。最初的表现是相对良性的，但随后的过程是严重的秋水仙碱中毒，导致死亡严重的秋水仙碱毒性可导致进行性器官功能障碍和排除功能受损的恶性循环乔沙霉素是共摄食物之一，也是p -糖蛋白的抑制剂，p -糖蛋白是引起多药耐药的膜泵，它可能在阻碍秋水仙碱的细胞和胆道清除方面发挥了重要作用。摄入的阿片类药物和抗胆碱能化合物可能改变秋水仙碱的吸收和胃肠道转运该病例提醒我们需要注意共摄药物，早期积极治疗，如果有的话，考虑免疫治疗。
1 Colchicine poisoning, which is relatively rare, is associated with significant morbidity and mortality. Whilst a new treatment modality, in the form of colchicine-specific Fab fragments is on the horizon, currently available therapy is largely supportive.2 The elimination of colchicine occurs primarily by hepatic metabolism, following a first-order process, with significant enterohepatic circulation. Renal extraction is responsible for approximately 20% of colchicine elimination.3 We report a case of colchicine intoxication, complicated by the presence of co-ingestants, in which serum colchicine concentrations remained quasi-constant over the 3 days of the patient's survival, consistent with marked alterations both in metabolism and excretion. The initial presentation was relatively benign but the subsequent course was one of severe colchicine poisoning, resulting in death.4 Severe colchicine toxicity appears to have resulted in a vicious cycle of progressive organ dysfunction and impaired elimination.5 Josamycin, one of the co-ingestants and an inhibitor of P-glycoprotein, the membrane pump responsible for multidrug resistance, may have played a significant role in impeding the cellular and biliary elimination of colchicine. Go-ingested opioid and anticholinergic compounds may have altered colchicine absorption and gastrointestinal transit.6 This case serves as a reminder of the need for attention to co-ingested drugs, tb early aggressive therapy, and if available, to consideration of immunotherapy.