Treatment of Pediatric Colchicine Poisoning with Single-Pass Albumin Dialysis: A Case Report.

A 15-year-old patient presented to the emergency department with symptoms of abdominal pain and vomiting after intentionally ingesting colchicine, a medication with a narrow therapeutic index. The patient had taken a dose of 0.56 mg/kg, which is considered toxic and has a high mortality rate. Within 24 hours of ingestion, the patient developed multi-organ injury, including hepatic dysfunction, coagulopathy, lactic acidemia, and pancytopenia. Due to the severity of these symptoms, the medical team considered using extracorporeal therapy (ECT) to support the patient's recovery. The characteristics of colchicine, including its high protein binding and variable volume of distribution, made it a challenging substance to remove from the body. The medical team decided to treat the patient with continuous venovenous hemodiafiltration (CVVHDF) combined with single-pass albumin dialysis (SPAD) for 42 hours. This approach was chosen due to the high protein binding of colchicine, which made it difficult to remove using conventional dialysis methods. The addition of SPAD was intended to enhance the elimination of protein-bound fractions of the drug. The principle behind SPAD is that adding albumin to the dialysate creates a protein-binding disequilibrium, allowing the drug to bind to albumin on the dialysate side and be removed from the body. The patient responded well to this treatment and was discharged from the intensive care unit 48 hours after stopping CVVHDF, with normal kidney function, resolved coagulopathy, and resolving pancytopenia and hepatic dysfunction. The use of CVVHDF with SPAD in this case suggests that continuous kidney replacement therapy with SPAD may be a valuable consideration for patients with colchicine poisoning, particularly those who have ingested doses greater than 0.5 mg/kg.