The 7.4 magnitude earthquake, the most powerful to strike the South American country in decades, tore through Colombia's coffee-growing heartland early on Monday, reduced multi-storey buildings to rubble in cities such as Pereira and Cali, and caused one of the spires of a cathedral in the city of Manizales to collapse.
Emergency teams aided by police, soldiers and volunteers worked through the night with excavators and, at times, their bare hands, hunting for survivors beneath debris.
Jose Fernando Usma, head of search and rescue for the Quindio branch of the Colombian Red Cross, said rescuers had detected sounds and some signs that could indicate survivors beneath the rubble, and were assessing damaged structures and removing debris to reach people trapped deeper inside.
"We still have a big window of time. We have approximately 24 more hours to have hope of life," he said.
In Cali, with a population of about 2.2 million, at least 95 people were killed.
Dozens of buildings were left leaning precariously or destroyed outright, forcing residents into the streets.
Several of the top floors of one of the city's hospitals - some dedicated to pediatric care - collapsed upon themselves, leaving some patients trapped and forcing about 600 others to be tended to on a street strewn with rubble, hospital director Irne Torres Castro told Caracol television.
Carmen Yasmin Garcia, 43, a Cali resident volunteering with rescue teams, said on Monday afternoon that her group had freed seven people from a collapsed building but four others and a dog remained trapped.
"A moment ago there was scratching but now we can't hear anything. We still have faith that the dog is alive and we can get these people out," Garcia said.
"We need people with sticks and spades, the more people lending a hand the better."
In Pereira, the capital of the hard-hit Risaralda region, authorities reported 72 deaths while officials in neighbouring Valle del Cauca, which includes Cali, reported 38 fatalities.
Pereira also bore some of the most visible destruction, with entire residential blocks reduced to piles of concrete and twisted steel.
Video posted on social media and verified by Reuters showed the city's airport violently swaying during the quake, with large chunks of the ceiling collapsing as people took shelter.
Another 13 people died in Choco, the rural province closest to the quake's epicentre.
President Abelardo De La Espriella, who assumed power just days ago, said 1000 members of the security forces would be deployed to Cali by dawn following reports of looting.
Cali, as well as Pereira, implemented curfews on Monday night.
"Our intention is to co-operate in any way necessary. Here, there are no distinctions or ideological divisions when it comes to defending our people or showing solidarity," De La Espriella told journalists on Monday evening.
The disaster has drawn comparisons to a deadly 1999 earthquake that devastated the same coffee-growing region, killing more than 1000 people, as well as to catastrophic quakes that killed more than 6300 in neighbouring Venezuela in June.
