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

A 15-year-old patient presented to the emergency department with abdominal pain and vomiting after intentionally ingesting colchicine, a medication with a narrow therapeutic index, at a dose of 0.56 mg/kg, which is considered toxic. Within 24 hours of ingestion, the patient developed a multi-organ injury, including hepatic dysfunction, coagulopathy, lactic acidemia, and pancytopenia, which prompted the consideration of extracorporeal therapy (ECT) to support their recovery. Given the patient's critical condition and the high mortality risk associated with colchicine toxicity, the medical team decided to treat the patient with continuous venovenous hemodiafiltration (CVVHDF) with single-pass albumin dialysis (SPAD) for 42 hours. The rationale behind using CVVHDF with SPAD was based on the pharmacokinetic properties of colchicine, including its high protein binding, variable volume of distribution, and previous reports showing a limited ability to remove the drug through conventional dialysis. The addition of SPAD was intended to enhance the elimination of protein-bound fractions of colchicine, which is achieved by creating a protein-binding disequilibrium between the blood and dialysate. This approach allowed for continuous clearance of the drug, facilitating redistribution from the extravascular to intravascular space and minimizing the risk of rebound. The treatment was successful, and the patient was discharged from the intensive care unit 48 hours after stopping CVVHDF, with normal kidney function, resolved coagulopathy, and resolving pancytopenia and hepatic dysfunction. This case highlights the potential benefits of using continuous kidney replacement therapy with SPAD in the management of colchicine toxicity, particularly in cases where the dose ingested is >0.5 mg/kg, which is associated with a high mortality risk.