Related Experiment Video

Updated: Aug 14, 2026

Multi-Gene Single Nucleotide Polymorphism Detection in Gastric Cancer Based on Ion Semiconductor Sequencing Platform
06:21

Multi-Gene Single Nucleotide Polymorphism Detection in Gastric Cancer Based on Ion Semiconductor Sequencing Platform

Published on: May 10, 2024

Iatrogenically-related, fatal methotrexate intoxication: a series of four cases

A Moisa1, P Fritz, D Benz

  • 1Institut für Gerichtliche Medizin der Universität Tübingen, Nägelestr. 5, 72074 Tübingen, Germany. adina.moisa@uni-tuebingen.de

Forensic Science International
|December 14, 2005
PubMed

Insights

Methotrexate (MTX) is a vital rheumatoid arthritis drug, but overdose can be fatal. Medical malpractice cases highlight the critical need for better physician education on MTX toxicity and safe dosing.

Area of Science:

  • Pharmacology
  • Rheumatology
  • Forensic Medicine

Background:

  • Methotrexate (MTX), a folic antagonist, has been a cornerstone in long-term rheumatoid arthritis treatment since the early 1980s.
  • Effective MTX therapy necessitates rigorous clinical and laboratory monitoring, alongside comprehensive patient education to mitigate risks.

Observation:

  • This report details four fatal cases of MTX intoxication resulting from medical malpractice, identified within the Tübingen Institute of Forensic Medicine's autopsy archives.
  • These cases underscore the severe, life-threatening consequences of MTX overdose.

Findings:

  • A significant knowledge gap exists regarding MTX toxicity and appropriate dose limitations, particularly among non-rheumatologists.
  • Medical malpractice involving MTX overdose can lead to fatal outcomes.

Implications:

  • Enhanced medical education on MTX's toxic potential and safe prescribing practices is crucial, especially for physicians not specializing in rheumatology.
  • Improved awareness and adherence to dosing guidelines are essential to prevent MTX-related fatalities.

Related Concept Videos

Pharmaceutical Poisoning: Potential Scenarios01:26

Pharmaceutical Poisoning: Potential Scenarios

Pharmaceutical poisoning can occur through various channels, impacting an estimated 2 million hospitalized patients in the U.S. annually with serious adverse drug responses. These scenarios encompass both therapeutic uses, such as drug toxicity, where even standard dosages can lead to severe central nervous system depression, and non-therapeutic exposures, including accidental ingestion by children, and environmental and occupational exposures.Unintentional poisonings often involve exploratory...
Therapeutic Drug Monitoring: Affecting Factors01:29

Therapeutic Drug Monitoring: Affecting Factors

Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
Drug Toxicity: Dose-Dependent Reactions01:24

Drug Toxicity: Dose-Dependent Reactions

Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
Pharmaceutical Poisoning: Treatment Strategies01:26

Pharmaceutical Poisoning: Treatment Strategies

Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
Toxidromes: Clinical Features01:30

Toxidromes: Clinical Features

Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...
Drug Toxicity: Overview01:00

Drug Toxicity: Overview

Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...