title: Methotrexate toxicity treated with continuous venovenous hemofiltration, leucovorin and glucarpidase.
abstract: High-dose methotrexate (MTX) can produce acute kidney injury, impairing MTX elimination. Continuous venovenous hemofiltration (CVVH) may enhance elimination in this setting, although its use is largely unstudied. A 79-year-old man received IV MTX for central nervous system lymphoma, and over a 34-h period his serum creatinine increased from 1.09 to 2.24 mg/dL. His serum MTX concentration (sMTX) at the end of this time period was 59.05 µmol/L. After urinary alkalinization and leucovorin and glucarpidase (CPDG2) treatment, sMTX decreased. Fluid overload ensued and CVVH was initiated. The initial MTX extraction ratio and clearance were 0.22 and 47.0 mL/min, respectively. No MTX extraction occurred at an sMTX of 0.15 µmol/L. Continuous venovenous hemodialysis was initiated, and sMTX further declined. CVVH may help eliminate MTX and provide renal replacement at moderate sMTX.
authors: Division of Emergency Medicine, Department of Medicine , Medical University of South Carolina , SC , USA.
authors: Nicholas J
authors: NJ
authors: Connors
authors: Division of Nephrology, Department of Medicine , Columbia University Medical Center , New York, NY , USA.
authors: Meghan E
authors: ME
authors: Sise
authors: New York City Poison Control Center , New York, NY , USA ; Division of Medical Toxicology, Department of Emergency Medicine , New York University School of Medicine , New York, NY , USA.
authors: Lewis S
authors: LS
authors: Nelson
authors: New York City Poison Control Center , New York, NY , USA ; Division of Medical Toxicology, Department of Emergency Medicine , New York University School of Medicine , New York, NY , USA.
authors: Robert S
authors: RS
authors: Hoffman
authors: New York City Poison Control Center , New York, NY , USA ; Division of Medical Toxicology, Department of Emergency Medicine , New York University School of Medicine , New York, NY , USA.
authors: Silas W
authors: SW
authors: Smith
keywords: acute kidney injury; continuous venovenous hemofiltration; methotrexate