Paediatric colchicine poisoning in the UK: a 10-year retrospective case series from the National Poisons Information Service

Abstract

Objective: Colchicine, derived from autumn crocus (Colchicum autumnale), has been used for centuries to treat arthritis. Currently, colchicine is licensed in the UK for the treatment of gout and familial Mediterranean fever. Off-label uses include pericarditis and potentially acute coronary syndrome and coronary artery disease. This study was performed to characterise colchicine poisoning in children in the UK.

Design: A retrospective analysis of telephone enquiries regarding colchicine to the National Poisons Information Service (NPIS) recorded in the UK Poisons Information Database (UKPID).

Setting: All UKPID data on colchicine poisoning between 2011 and 2021.

Patients: All patients less than 18 years old with colchicine exposure where telephone advice was sought from NPIS.

Main outcome measures: The contemporaneous demographics, epidemiology, morbidity, mortality and dose ingested (if available).

Results: Over the decade, 57 cases (median age 7 years, range 0-17 years) were reported to NPIS, yielding a minimum incidence of 0.41 cases/million children/year. Outcome data were available in 13/57 (23%) cases. Around half, 30 (52%) were symptomatic at presentation, with gastrointestinal disturbance being the most common symptom in 22 cases (39%). 12 patients (21.1%) progressed to systemic toxicity, with 7 (12%) suffering multiple organ failure and there were 4 deaths (7%). Estimated ingested doses ranged from 0.01 mg/kg to 1.45 mg/kg. Fatalities occurred at doses of between 0.21 to 1.45 mg/kg; all were mixed overdoses.

Conclusions: Colchicine overdose in children is infrequent but can be fatal. Colchicine poisoning in children can present asymptomatically and progress to systemic toxicity. Paediatricians should be aware of the potential severity of toxicity from colchicine overdose.