Pediatric case of accidental oral overdose of methotrexate

Area of Science:

• Pharmacology
• Toxicology
• Pediatrics

Background:

• Methotrexate (MTX) is a chemotherapy agent and folic acid antagonist inhibiting dihydrofolate reductase.
• MTX overdose can lead to severe multi-organ toxicity, including bone marrow, liver, and kidney damage.
• Increasing MTX use for neoplastic, dermatologic, and rheumatologic conditions raises the risk of accidental overdoses.

Purpose of the Study:

• To report the successful management of an accidental methotrexate overdose in a pediatric patient.
• To emphasize the critical role of prompt leucovorin rescue in mitigating MTX toxicity.

Main Methods:

• A 2-year-old child ingested a significant overdose of methotrexate.
• Treatment included gastric lavage, activated charcoal, and leucovorin rescue.
• The patient was admitted to the Intensive Care Unit (ICU) for monitoring.

Main Results:

• The child's initial serum methotrexate level was 10 times the toxic threshold.
• Clinical course was unremarkable with no significant sequelae.
• Mild, transient elevation in liver enzymes was the only evidence of toxicity, resolving spontaneously.

Conclusions:

• Early and aggressive intervention, including leucovorin rescue, is effective in treating methotrexate overdose.
• Leucovorin administration, at a dose equal to or exceeding the estimated ingestion, should be initiated as soon as possible.
• Pediatric accidental methotrexate ingestion requires prompt medical attention to prevent severe toxicity.