Accidental colchicine poisoning with fatal outcome after ingestion of meadow saffron (Colchicum autumnale L.)

Miloš Danilović; Jelena  Isailović; Ivan Aleksić; Jelena  Džambas; Nadica Marinković

doi:10.2298/VSP180413034D

Miloš Danilović Medicinski fakultet Vojnomedicinske akademije Univerzitet odbrane u Beogradu
Jelena Isailović Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia
Ivan Aleksić Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia
Jelena Džambas Military Medical Academy, Institute for Pathology and Forensic Medicine, Belgrade, Serbia
Nadica Marinković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180413034D

Ključne reči: trovanje, kolhicin, biljke, otrovne, insuficijencija više organa, smrt

Sažetak

Uvod. Mrazovac (Colchicum autumnale L.) je višegodišnja zeljasta biljka iz familije ljiljana (Liliacea), sličan jestivoj biljci sremuš (Allium ursinum L.). Toksična supstanca u mrazovcu je alkaloid kolhicin. Trovanje kolhicinom je veoma opasno stanje, koje se može završiti smrtnim ishodom. Prikaz bolesnika. Muškarac starosti 50 godina primljen je u bolnicu zbog sumnje na zadesno trovanje biljkom mrazovac. Bolesnik je dan pre pojeo dve biljke misleći da su sremuš. Sedam sati nakon ingestije počele su tegobe: malaksalost, bolovi u abdomenu, mučnina, povraćanje i prolivaste stolice bez krvi sa kliničkom slikom gastroenterokolitisa, akutnom bubrežnom insuficijencijom, lezijom jetre, kardiorespiratornom insuficijencijom i smrtnim ishodom. Obdukcijom je makroskopski ustanovljeno: edem mozga, edem i kongestija pluća, srce mase 700 g sa hipertrofijom leve i desne komore, fibroza miokarda, kongestija i steatoza jetre, kongestija slezine, fibroza pankreasa. Uzeti su isečci organa za patohistološku analizu i telesne tečnosti i delovi organa za toksikološko-hemijsku analizu. Patohistološki nalaz je bio: edem mozga, difuzna perivaskularna i intersticijalna fibroza miokarda, intersticijalno krvarenje u miokardu, kongestija i edem pluća, mikrovezikularna i makrovezikularna steatoza jetre i centrilobularna nekroza jetre, limfocitni zapaljenski infiltrat u portnim prostorima jetre, kongestija crvene pulpe slezine, kongestija i intersticijalno krvarenje u bubregu, koagulaciona nekroza proksimalnih tubula bubrega. Toksikološko-hemijskom analizom potvrđeno je prisustvo kolhicina u: krvi – 0,011 mg/L, urinu – 0,051 mg/L, jetri sa žučnom kesom – 0,007 mg/kg, bubregu – 0,008 mg/kg. Zaključeno je da je bolesnik zadesno otrovan alkaloidom kolhicinom sa smrtnim ishodom. Zaključak. Ingestija biljke mrazovac, zbog prisustva toksičnog alkaloida kolhicina, može dovesti do trovanja sa smrtnim ishodom. Na trovanje kolhicinom treba posumnjati kod bolesnika sa gastrointestinalnim simptomima posle konzumiranja divljih biljaka.

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Zadesno trovanje kolhicinom sa smrtnim ishodom nakon ingestije biljke mrazovac (Colchicum autumnale L.)

Sažetak

Reference