Cerebrospinal fluid exchange after intrathecal methotrexate overdose. A report of two cases.
Two patients aged 11 and four years, were accidentally given a 10-fold overdose of intrathecal methotrexate while being treated for malignant disease. Neither patient developed any signs of neurotoxicity and exchange of lumbar cerebro-spinal fluid was started 3 and 5 h later, respectively. In one of the patients, who received 120 mg of methotrexate intrathecally, 31% of the given dose was recovered during 2 h of cerebrospinal fluid exchange that was started 3 h after the accidental overdosage. No sequelae were observed in any of the patients. Cerebrospinal fluid exchange is safe and can be recommended in all cases of intrathecal methotrexate overdosage. Ventriculo-cisternal perfusion is not necessary in cases of a 10-fold overdose if the patient has no signs of acute neurotoxicity.
Jakobson
A M
AM
Department of Paediatrics, Akademiska sjukhuset, Uppsala, Sweden.
Kreuger
A
A
Mortimer
O
O
Henningsson
S
S
Seidel
H
H
Moe
P J
PJ
D002555:Cerebrospinal Fluid / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008508:Medication Errors; D008727:Methotrexate / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000506:poisoning*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012965:Sodium Chloride / Q000008:administration & dosage*; D013129:Spinal Puncture
D012965:Sodium Chloride; D008727:Methotrexate