Prescription Dictum; Case Report on Unintentional Overdose of Methotrexate

Methotrexate is used to treat a range of adult and childhood cancers. High dose methotrexate can cause signicant toxicity, including acute kidney injury (AKI) in 2%-12% of patients. Crystallization of methotrexate deposits in renal tubules causing nephrotoxicity causing decreased clearance and increasing level of serum methotrexate causing myelosuppression, mucositis, dermatologic toxicity, and hepatotoxicity. Monitoring RFT, LFT serum creatinine, urine output, and serum methotrexate concentration are closely monitored. Treatment includes adequate hydration, urinary alkalinization, and leucovorin rescue to prevent complications. When delayed methotrexate excretion or AKI occurs despite preventive strategies, increased hydration, high-dose leucovorin, and glucarpidase are usually sufcient to allow renal recovery without the need for dialysis. Refractory cases require hemodialysis if the patient not improving to the abovementioned strategies.1