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Continuous veno-venous hemodiafiltration in methotrexate intoxication.
Helena Ziółkowska1, Agnieszka Kisiel, Beata Leszczyńska
1Marszalkowska Str. 24, Warsaw 00-576, Poland, hziolkowska@wum.edu.pl.
Medycyna Wieku Rozwojowego
|February 13, 2014
Summary
Severe methotrexate intoxication in children treated with continuous veno-venous hemodiafiltration (CVVHDF) showed effective drug elimination. CVVHDF successfully reduced toxic methotrexate levels and supported organ function recovery in pediatric osteosarcoma patients.
Area of Science:
- Oncology
- Nephrology
- Pharmacology
Background:
- High-dose methotrexate (MTX) is crucial for osteosarcoma treatment but carries significant nephrotoxicity and hepatotoxicity.
- Standard prophylaxis (fluid therapy, urine alkalization) may not prevent MTX crystal nephropathy, leading to systemic intoxication.
- Severe MTX intoxication can cause multiorgan injury, including liver, kidney, gastrointestinal, and bone marrow impairment.
Observation:
- Three pediatric patients (9-16 years) with osteosarcoma experienced severe MTX intoxication.
- Despite intensive fluid therapy, urine alkalization, and leucovorin, MTX levels remained toxic (660-1238 µmol/L at 24 hours).
- All patients presented with multiorgan injury.
Findings:
- Continuous veno-venous hemodiafiltration (CVVHDF) effectively reduced MTX concentrations to <1.5 μmol/L within 24-156 hours.
- Complete recovery of kidney and liver function was observed in all treated patients.
- CVVHDF proved to be a crucial supportive therapy for MTX elimination.
Implications:
- CVVHDF is a highly effective intervention for managing severe methotrexate toxicity in pediatric oncology.
- This case series highlights the critical role of advanced renal replacement therapy in mitigating MTX-induced organ damage.
- Optimizing MTX treatment protocols may involve integrating CVVHDF for high-risk patients to prevent severe complications.
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