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citolisis hep&#225;tica&#44; rabdomiolisis y deterioro de funci&#243;n renal&#46; En las siguientes 36<span class="elsevierStyleHsp" style=""></span>h desarrolla fallo cardiovascular y respiratorio&#44; precisando de intubaci&#243;n y ventilaci&#243;n mec&#225;nica a las 48<span class="elsevierStyleHsp" style=""></span>h por hipoxemia e inicio de perfusi&#243;n de vasoactivos e inotropos con noradrenalina y dobutamina &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Evoluciona a s&#237;ndrome de distress respiratorio agudo con relaci&#243;n P<span class="elsevierStyleInf">a</span>O<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 150 con F<span class="elsevierStyleInf">i</span>O<span class="elsevierStyleInf">2</span> 60&#37; y PEEP de 10<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La monitorizaci&#243;n hemodin&#225;mica invasiva &#40;sistema PiCCO<span class="elsevierStyleSup">&#174;</span>&#44; PULSION Medical Systems AG&#41; muestra datos de shock mixto cardiog&#233;nico y distributivo&#46; Se realiza ecocardiograma transtor&#225;cico que evidencia depresi&#243;n mioc&#225;rdica sin trastornos de contractilidad segmentaria&#44; atribuible a efecto cardiot&#243;xico&#44; presentando elevaci&#243;n de troponina <span class="elsevierStyleSmallCaps">i</span>&#46; Aparece trombopenia y leucopenia progresivas&#44; acidosis metab&#243;lica y fallo renal agudo olig&#250;rico que precisa de terapias de depuraci&#243;n extracorp&#243;rea con hemodialfiltraci&#243;n venovenosa continua mal tolerada por inestabilidad hemodin&#225;mica acusada&#46; Posteriormente&#44; aparece fallo hep&#225;tico y coagulopat&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Desarrolla s&#237;ndrome febril y agranulocitosis que se interpreta como sepsis y que se trata con linezolid&#44; cefepime&#44; amikacina y fluconazol tras toma de cultivos y con factor estimulante de colonias de granulocitos&#46; Evoluciona a fallo multiorg&#225;nico refractario a medidas de soporte&#44; falleciendo a las 92<span class="elsevierStyleHsp" style=""></span>h del ingreso&#46; Se recibe post m&#243;rtem el resultado de los cultivos&#44; identificando como agentes etiol&#243;gicos de shock s&#233;ptico <span class="elsevierStyleItalic">Escherichia coli</span> y <span class="elsevierStyleItalic">Streptococcus parasanguinis</span> en hemocultivos y <span class="elsevierStyleItalic">Enterococcus faecalis</span> en urocultivo&#44; sensibles a antibioterapia pautada&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La colchicina es un alcaloide natural liposoluble derivado de plantas como la <span class="elsevierStyleItalic">Colchicum autumnale</span> y la <span class="elsevierStyleItalic">Gloriosa superba</span>&#46; Se emplea como medicamento en el tratamiento de la artritis gotosa aguda y recurrente&#44; fiebre mediterr&#225;nea familiar&#44; esclerodermia y amiloidosis secundaria entre otras enfermedades<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Sus efectos antiinflamatorios se basan en su capacidad antimit&#243;tica al interferir en el ensamblaje del citoesqueleto mediante la uni&#243;n reversible y selectiva a la tubulina&#44; componente fundamental de los microt&#250;bulos&#46; Inhibe la mitosis&#44; la fagocitosis y la migraci&#243;n leucocitaria secundaria al dep&#243;sito tisular de cristales de &#225;cido &#250;rico&#46; Adem&#225;s&#44; disminuye la producci&#243;n de &#225;cido l&#225;ctico leucocitario y consecuentemente la precipitaci&#243;n de los cristales de urato<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Tambi&#233;n interviene en la cadena de producci&#243;n de prostaglandinas modulando la actividad de COX-1 y COX-2<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; La semivida de eliminaci&#243;n var&#237;a de 4 a 30<span class="elsevierStyleHsp" style=""></span>h&#44; aumentando en caso de enfermedad hep&#225;tica&#44; renal o empleo concomitante con inhibidores enzim&#225;ticos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La colchicina tiene un estrecho margen terap&#233;utico&#44; no aconsej&#225;ndose en la actual ficha t&#233;cnica del medicamento de la Agencia Espa&#241;ola del Medicamento y Productos Sanitarios &#40;AEMPS&#41; m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>mg en 24<span class="elsevierStyleHsp" style=""></span>h hasta un m&#225;ximo de 4<span class="elsevierStyleHsp" style=""></span>d<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; La intoxicaci&#243;n aguda es poco frecuente pero de alta morbimortalidad&#46; Entre los factores de riesgo que pueden originar intoxicaciones agudas accidentales est&#225;n el f&#225;cil acceso por parte de los pacientes al f&#225;rmaco para automedicaci&#243;n o la ingesta de las plantas ricas en alcaloide en forma de ensaladas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Dosis superiores a 0&#44;4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg producen cuadros graves e incluso letales y mayores a 0&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg suelen ser mortales&#44; aunque se han descrito casos de supervivencia tras la presunta ingesta de 350<span class="elsevierStyleHsp" style=""></span>mg<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Existe gran variabilidad entre la dosis ingerida y cl&#237;nica&#44; explic&#225;ndose esta por las interacciones con f&#225;rmacos ingeridos concomitantemente que act&#250;en como potentes inhibidores del citocromo CYP 34A y la glicoprote&#237;na-P &#40;antirretrovirales&#44; ketoconazol&#44; claritromicina&#44; fluoxetina&#44; estatinas&#44; ciclosporina y tacrolimus entre otros&#41;&#44; variabilidad interindividual en la respuesta y presencia de enfermedades hep&#225;ticas y renales&#44; lo que explica que tambi&#233;n se hayan descrito casos mortales solamente con la ingesta de 7<span class="elsevierStyleHsp" style=""></span>mg<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La sobredosificaci&#243;n de colchicina debe considerarse siempre una emergencia&#44; 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ya que su elevaci&#243;n es buen predictor de fallo cardiovascular<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">El tratamiento consiste en medidas de soporte en la Unidad de Cuidados Intensivos&#44; con ingreso de todo paciente en quien se sospeche intoxicaci&#243;n&#46; Inicialmente hay que retrasar la absorci&#243;n del t&#243;xico mediante lavado g&#225;strico y carb&#243;n activado en dosis repetidas o lavado intestinal total&#44; soporte hemodin&#225;mico y respiratorio&#44; antibioterapia de amplio espectro&#44; factores estimuladores de colonias de granulocitos<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> y terapias de depuraci&#243;n extrarrenal en caso de desarrollo de fracaso renal agudo&#44; aunque no con la intenci&#243;n de aumentar la eliminaci&#243;n del t&#243;xico sino como tratamiento de soporte&#44; ya que por su alto volumen de distribuci&#243;n&#44; liposolubilidad y elevada uni&#243;n a prote&#237;nas plasm&#225;ticas no es dializable<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a>&#46; No existe ant&#237;doto espec&#237;fico pero se ha empleado inmunoterapia de modo experimental mediante la administraci&#243;n de anticuerpos monoclonales Fab de alta afinidad por la colchicina&#44; redistribuy&#233;ndola de los tejidos hacia el plasma aumentando su concentraci&#243;n en sangre y disminuyendo la concentraci&#243;n de colchicina libre con efecto t&#243;xico&#44; con mejor&#237;a cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Desafortunadamente su uso comercial no est&#225; disponible actualmente&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El caso refleja un error de interpretaci&#243;n de dosificaci&#243;n con resultado fatal&#44; por lo que fue notificado oficialmente a trav&#233;s del Centro Auton&#243;mico de Farmacovigilancia a la AEMPS&#44; la cual hizo un comunicado de riesgos de medicamentos para profesionales sanitarios<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Urgencias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">36<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">48<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">60<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">72<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">84<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leucocitos &#40;cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;900&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos &#40;cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;400&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#46;900&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">900&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hb &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">44&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Creatin Kinasa &#40;U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Bi total &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab346873.png"
              ]
            ]
            1 => array:2 [
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                  \t\t\t\t">Noradrenalina &#40;mcg&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab346874.png"
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          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Valores con inestabilidad hemodin&#225;mica y fallo renal agudo olig&#250;rico&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara">Valores con terapia de reemplazo renal continuo&#58; hemodialfiltraci&#243;n venovenosa continua&#46;</p>"
            ]
          ]
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Carta científica
Sobredosis letal accidental de colchicina
Accidental fatal colchicine overdose
R. Herrán-Mongea,
Autor para correspondencia
ruben.herran.monge@gmail.com

Autor para correspondencia.
, A. Muriel-Bombína, M. García-Garcíaa, A. Dueñas-Laitab, M.L. Fernández-Rodrígueza, A.M. Prieto de Lamoa
a Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
b Unidad Regional de Toxicología Clínica, Hospital Universitario Río Hortega, Valladolid, España
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citolisis hep&#225;tica&#44; rabdomiolisis y deterioro de funci&#243;n renal&#46; En las siguientes 36<span class="elsevierStyleHsp" style=""></span>h desarrolla fallo cardiovascular y respiratorio&#44; precisando de intubaci&#243;n y ventilaci&#243;n mec&#225;nica a las 48<span class="elsevierStyleHsp" style=""></span>h por hipoxemia e inicio de perfusi&#243;n de vasoactivos e inotropos con noradrenalina y dobutamina &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Evoluciona a s&#237;ndrome de distress respiratorio agudo con relaci&#243;n P<span class="elsevierStyleInf">a</span>O<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 150 con F<span class="elsevierStyleInf">i</span>O<span class="elsevierStyleInf">2</span> 60&#37; y PEEP de 10<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La monitorizaci&#243;n hemodin&#225;mica invasiva &#40;sistema PiCCO<span class="elsevierStyleSup">&#174;</span>&#44; PULSION Medical Systems AG&#41; muestra datos de shock mixto cardiog&#233;nico y distributivo&#46; Se realiza ecocardiograma transtor&#225;cico que evidencia depresi&#243;n mioc&#225;rdica sin trastornos de contractilidad segmentaria&#44; atribuible a efecto cardiot&#243;xico&#44; presentando elevaci&#243;n de troponina <span class="elsevierStyleSmallCaps">i</span>&#46; Aparece trombopenia y leucopenia progresivas&#44; acidosis metab&#243;lica y fallo renal agudo olig&#250;rico que precisa de terapias de depuraci&#243;n extracorp&#243;rea con hemodialfiltraci&#243;n venovenosa continua mal tolerada por inestabilidad hemodin&#225;mica acusada&#46; Posteriormente&#44; aparece fallo hep&#225;tico y coagulopat&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Desarrolla s&#237;ndrome febril y agranulocitosis que se interpreta como sepsis y que se trata con linezolid&#44; cefepime&#44; amikacina y fluconazol tras toma de cultivos y con factor estimulante de colonias de granulocitos&#46; Evoluciona a fallo multiorg&#225;nico refractario a medidas de soporte&#44; falleciendo a las 92<span class="elsevierStyleHsp" style=""></span>h del ingreso&#46; Se recibe post m&#243;rtem el resultado de los cultivos&#44; identificando como agentes etiol&#243;gicos de shock s&#233;ptico <span class="elsevierStyleItalic">Escherichia coli</span> y <span class="elsevierStyleItalic">Streptococcus parasanguinis</span> en hemocultivos y <span class="elsevierStyleItalic">Enterococcus faecalis</span> en urocultivo&#44; sensibles a antibioterapia pautada&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La colchicina es un alcaloide natural liposoluble derivado de plantas como la <span class="elsevierStyleItalic">Colchicum autumnale</span> y la <span class="elsevierStyleItalic">Gloriosa superba</span>&#46; Se emplea como medicamento en el tratamiento de la artritis gotosa aguda y recurrente&#44; fiebre mediterr&#225;nea familiar&#44; esclerodermia y amiloidosis secundaria entre otras enfermedades<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Sus efectos antiinflamatorios se basan en su capacidad antimit&#243;tica al interferir en el ensamblaje del citoesqueleto mediante la uni&#243;n reversible y selectiva a la tubulina&#44; componente fundamental de los microt&#250;bulos&#46; Inhibe la mitosis&#44; la fagocitosis y la migraci&#243;n leucocitaria secundaria al dep&#243;sito tisular de cristales de &#225;cido &#250;rico&#46; Adem&#225;s&#44; disminuye la producci&#243;n de &#225;cido l&#225;ctico leucocitario y consecuentemente la precipitaci&#243;n de los cristales de urato<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Tambi&#233;n interviene en la cadena de producci&#243;n de prostaglandinas modulando la actividad de COX-1 y COX-2<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; La semivida de eliminaci&#243;n var&#237;a de 4 a 30<span class="elsevierStyleHsp" style=""></span>h&#44; aumentando en caso de enfermedad hep&#225;tica&#44; renal o empleo concomitante con inhibidores enzim&#225;ticos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La colchicina tiene un estrecho margen terap&#233;utico&#44; no aconsej&#225;ndose en la actual ficha t&#233;cnica del medicamento de la Agencia Espa&#241;ola del Medicamento y Productos Sanitarios &#40;AEMPS&#41; m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>mg en 24<span class="elsevierStyleHsp" style=""></span>h hasta un m&#225;ximo de 4<span class="elsevierStyleHsp" style=""></span>d<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; La intoxicaci&#243;n aguda es poco frecuente pero de alta morbimortalidad&#46; Entre los factores de riesgo que pueden originar intoxicaciones agudas accidentales est&#225;n el f&#225;cil acceso por parte de los pacientes al f&#225;rmaco para automedicaci&#243;n o la ingesta de las plantas ricas en alcaloide en forma de ensaladas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Dosis superiores a 0&#44;4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg producen cuadros graves e incluso letales y mayores a 0&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg suelen ser mortales&#44; aunque se han descrito casos de supervivencia tras la presunta ingesta de 350<span class="elsevierStyleHsp" style=""></span>mg<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Existe gran variabilidad entre la dosis ingerida y cl&#237;nica&#44; explic&#225;ndose esta por las interacciones con f&#225;rmacos ingeridos concomitantemente que act&#250;en como potentes inhibidores del citocromo CYP 34A y la glicoprote&#237;na-P &#40;antirretrovirales&#44; ketoconazol&#44; claritromicina&#44; fluoxetina&#44; estatinas&#44; ciclosporina y tacrolimus entre otros&#41;&#44; variabilidad interindividual en la respuesta y presencia de enfermedades hep&#225;ticas y renales&#44; lo que explica que tambi&#233;n se hayan descrito casos mortales solamente con la ingesta de 7<span class="elsevierStyleHsp" style=""></span>mg<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La sobredosificaci&#243;n de colchicina debe considerarse siempre una emergencia&#44; donde el diagn&#243;stico e inicio de tratamiento precoz es fundamental&#46; La evoluci&#243;n cl&#237;nica se presenta en 3 fases&#44; con r&#225;pida progresi&#243;n hacia el fallo multiorg&#225;nico &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Son factores de riesgo el infravalorar la intoxicaci&#243;n y demorar el tratamiento&#44; interacciones farmacol&#243;gicas concomitantes en el tratamiento habitual&#44; ingesta de altas dosis&#44; presentar leucocitosis &#62;<span class="elsevierStyleHsp" style=""></span>18&#46;000&#47;mm<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> en las primeras 24<span class="elsevierStyleHsp" style=""></span>h y la evoluci&#243;n con shock cardiog&#233;nico en las primeras 72<span class="elsevierStyleHsp" style=""></span>h&#46; La determinaci&#243;n seriada de troponina como marcador de da&#241;o mioc&#225;rdico en las primeras 24<span class="elsevierStyleHsp" style=""></span>h es &#250;til para identificar los pacientes en riesgo&#44; ya que su elevaci&#243;n es buen predictor de fallo cardiovascular<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">El tratamiento consiste en medidas de soporte en la Unidad de Cuidados Intensivos&#44; con ingreso de todo paciente en quien se sospeche intoxicaci&#243;n&#46; Inicialmente hay que retrasar la absorci&#243;n del t&#243;xico mediante lavado g&#225;strico y carb&#243;n activado en dosis repetidas o lavado intestinal total&#44; soporte hemodin&#225;mico y respiratorio&#44; antibioterapia de amplio espectro&#44; factores estimuladores de colonias de granulocitos<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> y terapias de depuraci&#243;n extrarrenal en caso de desarrollo de fracaso renal agudo&#44; aunque no con la intenci&#243;n de aumentar la eliminaci&#243;n del t&#243;xico sino como tratamiento de soporte&#44; ya que por su alto volumen de distribuci&#243;n&#44; liposolubilidad y elevada uni&#243;n a prote&#237;nas plasm&#225;ticas no es dializable<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7</span></a>&#46; No existe ant&#237;doto espec&#237;fico pero se ha empleado inmunoterapia de modo experimental mediante la administraci&#243;n de anticuerpos monoclonales Fab de alta afinidad por la colchicina&#44; redistribuy&#233;ndola de los tejidos hacia el plasma aumentando su concentraci&#243;n en sangre y disminuyendo la concentraci&#243;n de colchicina libre con efecto t&#243;xico&#44; con mejor&#237;a cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Desafortunadamente su uso comercial no est&#225; disponible actualmente&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El caso refleja un error de interpretaci&#243;n de dosificaci&#243;n con resultado fatal&#44; por lo que fue notificado oficialmente a trav&#233;s del Centro Auton&#243;mico de Farmacovigilancia a la AEMPS&#44; la cual hizo un comunicado de riesgos de medicamentos para profesionales sanitarios<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46;</p></span>"
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                  \t\t\t\t">Plaquetas &#40;n&#176;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Urea &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Creatin Kinasa &#40;U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Bi total &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AST &#8211; GOT &#40;U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ALT &#8211; GPT &#40;U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Amonio &#40;&#956;mol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IS &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RVS &#40;dinas&#46;s&#46;cm<span class="elsevierStyleSup">-5</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">809&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">843&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVLW &#40;ml&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dobutamina &#40;mcg&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noradrenalina &#40;mcg&#47;kg&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de par&#225;metros anal&#237;ticos y hemodin&#225;micos</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Sintomatolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fase<span class="elsevierStyleSmallCaps">i</span>&#40;4 a 24<span class="elsevierStyleHsp" style=""></span>h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastrointestinal &#40;n&#225;useas&#44; v&#243;mitos&#44; dolor abdominal&#44; diarrea en ocasiones hemorr&#225;gica&#44;&#41;Deshidrataci&#243;n e hipovolemiaLeucocitosis reactivaAlteraciones electrol&#237;ticas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fase <span class="elsevierStyleSmallCaps">ii</span>&#40;1 a 7<span class="elsevierStyleHsp" style=""></span>d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evoluci&#243;n a fallo multiorg&#225;nicoDepresi&#243;n medular&#58; leucopenia y trombopeniaCardiotoxicidad y shock cardiog&#233;nicoArritmias y muerte s&#250;bitaSepsis y shock s&#233;pticoInsuficiencia respiratoria aguda y SDRARabdomiolisisFallo renal olig&#250;ricoAcidosis metab&#243;licaFallo hep&#225;tico agudoDepresi&#243;n del nivel de concienciaConvulsiones y polineuropat&#237;a perif&#233;ricaMiopat&#237;aAfectaci&#243;n cut&#225;nea-necrolisis epid&#233;rmica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fase <span class="elsevierStyleSmallCaps">iii</span>&#40;7 a 14<span class="elsevierStyleHsp" style=""></span>d en supervivientes&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recuperaci&#243;n medular&#44; leucocitosis de reboteAlopecia transitoria&nbsp;\t\t\t\t\t\t\n
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