Ertuğrul İlker, Polat Emine, Özgür Senem, Doğan Vehbi, Yoldaş Tamer, Akşin Şeyma, Örün Utku Arman, Karademir Selmin
Division of Pediatric Cardiology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
Turk J Pediatr. 2015 Jul-Aug;57(4):398-400.
Colchicine, is an old and well-known drug, used for treatment of rheumatic diseases. Nausea, vomiting, abdominal pain, and diarrhea are the clinical symptoms of colchicine poisoning. Cardiotoxicity can lead to mortality. We report a case of colchicine intoxication complicated with complete heart block. A 9-year-old patient ingesting colchicine 0.4-0.5 mg/kg was transferred because of elevation of liver enzymes, and deterioration of kidney functions and cytopenia. History of colchicine ingestion had been unknown at time of admission. After initial fluid and electrolyte treatment electrolyte imbalance ameliorated but kidney and liver functions worsened. In the third day of admission (7th day of ingestion), she confessed taking colchicine pills. Her state of consciousness became comatose and endotracheal intubation required. She developed complete heart block requiring temporary transvenous pacemaker implantation in the fifth day of admission. One day after pacemaker implantation, cardiopulmonary arrest developed again and remained completely unresponsive to CPR, and died. Cardiotoxicity of colchicine is leading cause of mortality. Tachycardia and conduction anomalies are not rare, but complete AV block in pediatric patient has never been reported. Although underlying mechanism is not known colchicine may have a direct toxic effect on conduction.
秋水仙碱是一种古老且广为人知的药物，用于治疗风湿性疾病。恶心、呕吐、腹痛和腹泻是秋水仙碱中毒的临床症状。心脏毒性可导致死亡。我们报告一例秋水仙碱中毒并发完全性心脏传导阻滞的病例。一名9岁患者因肝酶升高、肾功能恶化和血细胞减少而转诊，其摄入秋水仙碱的剂量为0.4 - 0.5 mg/kg。入院时并不知晓其有秋水仙碱摄入史。经过初始的液体和电解质治疗，电解质失衡有所改善，但肾脏和肝脏功能却恶化了。入院第三天（摄入后第7天），她承认服用了秋水仙碱片。她的意识状态陷入昏迷，需要进行气管插管。入院第五天，她出现完全性心脏传导阻滞，需要临时经静脉植入起搏器。起搏器植入一天后，再次发生心肺骤停，对心肺复苏完全无反应，最终死亡。秋水仙碱的心脏毒性是导致死亡的主要原因。心动过速和传导异常并不罕见，但小儿患者出现完全性房室传导阻滞此前从未有过报道。虽然其潜在机制尚不清楚，但秋水仙碱可能对传导有直接毒性作用。
