Acute accidental methotrexate poisoning: Fatal consequences - An Indian experience

Area of Science:

• Pharmacology
• Toxicology
• Oncology
• Rheumatology

Background:

• Methotrexate (MTX) is a critical medication in oncology and rheumatology, inhibiting DNA synthesis and cellular replication.
• While effective at low doses for rheumatoid arthritis and psoriasis, MTX overdose or incorrect dosing can result in severe toxicity.
• Accidental MTX poisoning presents significant clinical challenges and necessitates prompt recognition and management.

Purpose of the Study:

• To present three cases of accidental methotrexate poisoning.
• To highlight the diverse clinical manifestations and management challenges associated with MTX toxicity.
• To emphasize the importance of preventing medication errors in MTX administration.

Main Methods:

• Case series presentation of three patients with accidental MTX poisoning.
• Clinical data collection on presenting symptoms, laboratory findings, and treatment course.
• Review of management strategies and supportive care provided.

Main Results:

• Patients exhibited symptoms including fever, weakness, mucocutaneous lesions, and pancytopenia.
• Cases required intensive care and supportive treatment, indicating the severity of MTX toxicity.
• The diverse manifestations underscore the complexity of managing MTX overdose.

Conclusions:

• Accidental MTX poisoning poses a serious risk, necessitating careful attention to dosing and administration.
• Patient education and pharmacist vigilance are vital in preventing medication errors.
• Enhanced clinician awareness is essential for timely diagnosis and effective management of MTX toxicity to ensure patient safety.