Delayed recognition of intrathecal methotrexate overdose.
A 10-year-old girl who presented to our hospital was diagnosed as having B-precursor cell acute lymphoblastic leukemia. St Jude's Total XIII protocol was started. In the second block of the consolidation phase, 10 hours after triple intrathecal treatment, we realized that instead of 12 mg, 120 mg of methotrexate had accidentally been given. Although the patient had no symptoms 10 hours after intrathecal treatment, to prevent the possible neurotoxic effects of methotrexate, a cerebrospinal fluid exchange was performed. Simultaneously, systemic dexamethasone and calcium folinic acid were given. At the time of this writing (2 y), the patient has had no symptoms and has continued on the chemotherapy protocol as planned. Administration of high-dose intrathecal methotrexate may not lead to symptoms, as was the case in our patient. This may be related to individual variations in cerebrospinal fluid dynamics and drug metabolism.
Department of Pediatric Hematology, Baskent University Faculty of Medicine, Ankara, Turkey. barismalbora@gmail.com
Baris
B
Malbora
Emel
E
Ozyurek
Aysu Inan
AI
Kocum
Namik
N
Ozbek
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000506:poisoning*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002555:Cerebrospinal Fluid; D002648:Child; D003561:Cytarabine / Q000008:administration & dosage; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008727:Methotrexate / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000506:poisoning*; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000134:cerebrospinal fluid* / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage
D000964:Antimetabolites, Antineoplastic; D018931:Antineoplastic Agents, Hormonal; D003561:Cytarabine; D011239:Prednisolone; D008727:Methotrexate