Successful treatment of intrathecal methotrexate overdose by using ventriculolumbar perfusion and intrathecal instillation of carboxypeptidase G2.


:Prompt and appropriate management measures are critical in order to achieve a favorable outcome after a major overdose of intrathecally (IT) administered methotrexate (MTX). Published information available to guide clinicians in the immediate management of this medical emergency is scant. Herein we describe a 6-year-old boy with acute lymphoblastic leukemia who received an inadvertent overdose of 600 mg of IT administered MTX instead of the intended dose of 12 mg. Severe acute neurotoxicity developed rapidly. Lumbar puncture and drainage of 15 mL of cerebrospinal fluid 2 hours after administration resulted in removal of 32% of the administered drug. Ventriculolumbar perfusion with 240 mL of warmed isotonic saline through ventricular and lumbar catheters for 3 hours resulted in removal of a total of 90% of the drug within 8 1/2 hours after administration. IT administration of 2,000 U of carboxypeptidase G2 (CPDG2), an enzyme that inactivates MTX, resulted in a further 150-fold reduction in cerebrospinal fluid MTX concentration. The patient experienced complete recovery. To our knowledge, this is the first reported case of the use of IT instillation of CPDG2 for the treatment of an overdose of IT administered MTX in a human, and it is only the second reported favorable outcome after an IT overdose of more than 500 mg of MTX. Minor IT overdoses of MTX can be managed by immediate lumbar drainage alone. Major overdoses may also necessitate prompt ventriculolumbar perfusion, IT instillation of CPDG2, and further supportive measures for a successful outcome after this infrequent but potentially catastrophic event.


Mayo Clin Proc


Mayo Clinic proceedings


O'Marcaigh AS,Johnson CM,Smithson WA,Patterson MC,Widemann BC,Adamson PC,McManus MJ




Has Abstract


1996-02-01 00:00:00














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    abstract:OBJECTIVE:To determine and quantify the in vivo effects of octreotide on the cell cycle kinetics of growth hormone-producing pituitary adenomas. DESIGN:A multicenter randomized trial had been conducted to assess the clinical efficacy of octreotide, and we studied tissue specimens from pituitary macroadenomas in 32 pat...

    journal_title:Mayo Clinic proceedings

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Thapar K,Kovacs KT,Stefaneanu L,Scheithauer BW,Horvath E,Lloyd RV,Li J,Laws ER Jr

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    journal_title:Mayo Clinic proceedings

    pub_type: 临床试验,杂志文章,评审


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    journal_title:Mayo Clinic proceedings

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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    更新日期:1991-01-01 00:00:00

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    pub_type: 杂志文章,多中心研究,随机对照试验


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    pub_type: 临床试验,杂志文章,随机对照试验


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