Bahadori Atessa, Patel Rishil, Robinson Cal, Balgobin Steve, Zappitelli Michael, Selvathesan Nithiakishna
Department of Paediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Case Rep Nephrol Dial. 2024 Dec 11;15(1):1-8. doi: 10.1159/000543020. eCollection 2025 Jan-Dec.
Colchicine has a narrow therapeutic index, and doses >0.5 mg/kg are considered toxic with a high mortality rate.
A previously healthy 15-year-old presents to the emergency department with abdominal pain and vomiting following intentional ingestion of colchicine (0.56 mg/kg) 12 h prior. By 24 h post-ingestion, they developed a multi-organ injury with hepatic dysfunction, coagulopathy, lactic acidemia, and pancytopenia, which prompted consideration of extracorporeal therapy (ECT). Considering the characteristics of colchicine, they were treated with continuous venovenous hemodiafiltration (CVVHDF) with single-pass albumin dialysis (SPAD) for 42 h. They were subsequently discharged from the intensive care unit 48 h after stopping CVVHDF with normal kidney function, resolved coagulopathy, and resolving pancytopenia and hepatic dysfunction. The rationale for CVVHDF with SPAD was based on the high protein binding, variably high volume of distribution, previous reports showing a sieving coefficient of 0.2 with CVVH, and the high mortality risk. We anticipated a high potential for rebound. Thus, continuous clearance would facilitate redistribution from the extravascular to intravascular space. SPAD was used to enhance the elimination of protein-bound fractions; the principle is that adding albumin to dialysate creates a protein-binding disequilibrium where the drug from the blood side may bind to albumin on the dialysate side.
Colchicine ingestion of >0.5 mg/kg is highly toxic, and in addition to supportive management, continuous kidney replacement therapy with SPAD may be considered.
秋水仙碱的治疗指数较窄，剂量>0.5mg/kg被认为具有毒性且死亡率高。
一名此前健康的15岁青少年在12小时前故意摄入秋水仙碱（0.56mg/kg）后因腹痛和呕吐就诊于急诊科。摄入后24小时，他们出现了多器官损伤，伴有肝功能障碍、凝血功能障碍、乳酸性酸中毒和全血细胞减少，这促使考虑进行体外治疗（ECT）。考虑到秋水仙碱的特性，他们接受了持续静脉-静脉血液透析滤过（CVVHDF）联合单通道白蛋白透析（SPAD）治疗42小时。在停止CVVHDF 48小时后，他们从重症监护病房出院，肾功能正常，凝血功能障碍得到缓解，全血细胞减少和肝功能障碍也得到缓解。采用CVVHDF联合SPAD的理由基于其高蛋白结合率、分布容积变化较大、既往报告显示CVVH的筛过系数为0.2以及高死亡风险。我们预计有很高的反弹可能性。因此，持续清除将有助于从血管外间隙向血管内间隙重新分布。使用SPAD来增强蛋白结合部分的清除；其原理是向透析液中添加白蛋白会产生蛋白结合不平衡，血液侧的药物可能会与透析液侧的白蛋白结合。
摄入秋水仙碱>0.5mg/kg具有高度毒性，除了支持性治疗外，可考虑采用联合SPAD的持续肾脏替代治疗。
