A large pediatric cohort of colchicine intoxication: prognostic factors and experience with rapid sequence apheresis

Severe colchicine intoxication often leads to multi-organ failure and death. With no specific antidote and ineffective conventional elimination methods, we hypothesized that rapid sequence apheresis could reduce the intravascular colchicine reservoir. This study describes pediatric colchicine poisoning, focusing on dose-related outcomes and the clinical role of rapid sequence apheresis.

This retrospective observational analysis included children admitted to a tertiary pediatric intensive care unit for colchicine poisoning (2011-2025). Clinical data, ingested dose, organ involvement, and patient characteristics were evaluated. Logistic regression and ROC analyses were used to identify variables associated with disease severity and poor outcomes, including those treated with rapid sequence apheresis.

Eighty-four patients were included (median dose: 0.3 mg/kg). Across dose groups (<0.5, 0.5-0.8, and >0.8 mg/kg), higher doses correlated with increased frequency of diarrhea (20.6%, 57.1%, and 57.1%, respectively, P = 0.071) and cardiovascular involvement (20.6%, 50%, and 71.4%, respectively; P = 0.004). Logistic regression showed that diarrhea significantly increased the likelihood of cardiovascular complications (OR: 3.24, P = 0.006). The ROC analysis identified thresholds of >0.39 mg/kg and >24 mg total dose as predictors of cardiovascular toxicity. Seventeen patients (20.2%) underwent rapid sequence apheresis. Despite advanced supportive care, five patients died, including two who ingested <0.5 mg/kg and received rapid sequence apheresis.

Our findings suggest that higher ingested doses and early gastrointestinal manifestations such as diarrhea may serve as indicators of increased risk for cardiovascular complications in pediatric colchicine intoxication. In addition, clinically significant toxicity may occur at doses lower than traditionally reported thresholds.

Pediatric colchicine intoxication may lead to significant cardiovascular complications even at relatively lower doses. Early recognition of high-risk clinical indicators, including gastrointestinal symptoms, leukocytosis, and ingested dose, may facilitate clinical risk stratification and early identification of patients at increased risk of adverse outcomes. Rapid sequence apheresis was used in selected severe cases in our cohort; however, its therapeutic role requires further investigation.