990 Available online at www.medicinescince.org ORIGINAL RESEARCH Medicine Science 2016;5(4):990-3 The etiology and autopsy findings in Colchicine intoxication-related deaths Servet Birgin Iritas 1 , Ahmet Hakan Dinc 2 , Baris Akduman 1 , Bora Ozdemir 1 , Ceylan Bal 3 , Hacer Y. Teke 1 , Mehtap Ozdemir 4 , Bulent Degirmenci 1 1 Department of Forensic Physician&Toxicology, The Council of Forensic Medicine, Ankara-Turkey 2 Department of Forensic Medicine, TBMM (The Grand National Assembly of Turkey) Hospital, Ankara, Turkey 3 Department of Biochemistry, Yıldırım Beyazıt University, Ankara, Turkey 4 Department of Morgue The Council of Forensic Medicine of İstanbul, Turkey Received 23 May 2016; Accepted 13 June 2016 Available online 16.06.2016 with doi: 10.5455/medscience.2016.05.8493 Abstract Colchicine is a drug which has a very narrow therapeutic range. This drug has been commonly used for Familial Mediterranean Fever (FMF), Behçet’s disease, gout arthritis and acute pseudo gout attacks. In this study, the investigation reports and autopsy reports written by the Council of Forensic Medicine of Ankara between the years 2010-2014 were retrospectively analyzed to find out presence in the cases related to colchicine. Six cases were identified as colchicine intoxication, while three of them used colchicine for medical purpose. In four cases, colchicine was found to have been used for suicidal purpose. Among these four cases, two used colchicine for treatment. In all of our cases, colchicine was detected in bile specimen. Alveolar pulmonary edema and petechial hemorrhage were observed in the lung in all cases. Colchicine was detected in blood in four of the cases. In two cases, the concentration was found to be in therapeutic ranges (0,012 mg/L and 0,018 mg/L), while the other two, in lethal levels (0.099 mg/L and 0,264 mg/L). The most frequent histopathological finding is alveolar pulmonary edema in colchicine intoxication autopsies. Colchicine is widely used alkaloid drugs with narrow therapeutic ranges. More than 0.8 mg / kg in the acute high dose has usually fatal effects. The deaths resulted from colchicine intoxication are mainly suicide-oriented. Similar to other suicides with medicines, they are common among women. In our cases, colchicine was used for intention of suicide in four incidents (66, 66%). Keywords: Autopsy, death, suicide, drug, colchicine, intoxication, forensic medicine, accident Introduction Colchicine, a drug derived from a plant named Colchicum autumnale, is a well-known alkaloid for long years. A subtype of this plant, Colchicum speciosum Steven, is particularly prevalent in the Eastern Black Sea costs. This drug is commonly used for Familial Mediterranean Fever (FMF), the Behçet’s disease, the Gout Arthritis and acute pseudogout attacks. The underlying mechanism of anti-inflammatory effect is the inhibition of the polymerization of α-β-tubulin heterodimers’ microtubules, resulting as a barrier to neutrophil and monocyte chemotaxis. [1-6]. Colchicine is absorbed rapidly after oral intake, then undergoes deacetylation via liver. 10% -20% is excreted through the kidneys, while the remaining is excreted by feces. It is stable in tissues for a long time, mostly more than 10 days. It accumulates in bone marrow, testes, lung, liver, kidney, spleen, GIS wall and leukocytes [7,8]. Colchicine is a drug which has a very narrow therapeutic range. There is no definite boundary between non-toxic, toxic and lethal doses. High acute doses more than 0.8 mg/kg usually culminate in death. The reported lowest lethal doses range from 7 to26 mg. Cytochrome P450 3A4 (CYP3A4) inhibitors such as clarithromycin, erythromycin, ketoconazole, and P-glycoprotein inhibitors increase the concentration of colchicine [9-12] The first toxic symptoms of colchicine intake at high doses are usually abdominal pain, diarrhea, nausea and vomiting. Tachypnea, electrolyte disorders, hypovolemia, hematologic effects, cardiac symptoms, kidney and liver failure can occur following these symptoms. The cause of death is usually multiple organ failure and sepsis [13,14]. In this study, based on the autopsy results, the main target is to describe the characteristics and statistical findings of colchicine intoxication. Emphasizing the most frequent symptoms in severe cases is considered to be important for the clinical diagnosis of colchicine intoxication cases beyond toxicological analyses in emergency services. Materials and Methods In this study, the autopsy reports between 2010- 2014 of the Council of Forensic Medicine of Ankara were analyzed retrospectively. Additionally corpse examination reports and prosecution investigation files were examined. Age, gender, physical properties, medical history, colchicine levels and histopathological findings were all evaluated as descriptive characteristics. Medicine Science International Medical Journal *Coresponding Author: Servet Birgin Iritas, Department of Forensic Physician&Toxicology, The Council Of Forensic Medicine, Ankara, Turkey E-mail: sbiritas@gmail.com