Colchicum Ad Nauseum

A 39-year-old man was admitted to hospital because of vomiting and diarrhoea. He had developed cardiomyopathy of unknown cause a decade earlier that was managed with diuretics and an angiotensin-converting enzyme inhibitor. Two years thereafter, insulindependent diabetes mellitus appeared. His HbA1c was controlled at 7.5%. Two weeks prior to admission, he developed a burning pain in both feet. On the advice of his father-in-law, he ingested tablets hourly to make the pain go away. He continued these instructions despite the development of nausea, vomiting and diarrhoea. After 30 tablets, he became so weakened that he presented to the emergency department. The patient was disoriented in relation to time and place. His blood pressure was 90/50mmHg, the heart rate was 110/min. The neck veins were flat, the heart was enlarged but no third heart sound was reported. The lungs were clear. The abdomen was soft with tenderness in the right upper quadrant. The liver was enlarged. There was no peripheral oedema. An arterial sample at room air revealed PaO2 63, PaCO2 32 (mmHg), HCO3 21mmol/l, pH 7.45. The chest roentgenogram showed an enlarged heart with suggestion of congestion. The haemoglobin was 12 g/dl, haematocrit 38 vol%, Na 128, Cl 90, K 5.5, Ca 2.5 (mmol/l). The bilirubin was 81 mmol/l, ALAT 1263, ASAT 537, alkaline phosphatase 400 (U/l). Amylase was 281U/l, serum creatinine was 330 mmol/l and myoglobin in the urine was 695 mg/l. The urine sodium was 59mmol/l and the urine potassium was 17mmol/l. The urinalysis disclosed þ1 protein and the urine sediment revealed granular, muddy-coloured casts. The patient was admitted to the intensive care unit. There, an ultrasound examination of the abdomen showed a distended, stone-free gallbladder surrounded by a collection of fluid, consistent with acalculous cholecystitis (Figure 1).