Riva L, Conter V, Rizzari C, Jankovic M, Sala A, Milani M
Clinica Pediatrica, Ospedale S. Gerardo di Monza, University of Milan, Italy.
Acta Paediatr. 1999 Jul;88(7):780-2. doi: 10.1080/08035259950169107.
A 7-y-old boy with acute lymphoblastic leukaemia (ALL) received 600 mg of i.v. methotrexate (MTX) over 2 h, followed by triple intrathecal therapy (TIT) with cytosine arabinoside 30 mg, methylprednisolone 10 mg and MTX 300 mg (instead of the prescribed 12 mg). Ninety minutes later the patient developed headache, loss of consciousness and generalized hypertonia. He was transferred to the Intensive Care Unit, intubated and treated with phenobarbital. Three hours after the TIT, the levogyrus form of folinic acid (equivalent to double doses of the racemic product) was started i.v. at a dose of 100 mg every 3 h for 24 h, and every 6 h in the following 24 h. Cerebrospinal fluid was examined and was found normal. The patient subsequently remained in normal neurological status. The favourable outcome in our case suggests that folinic acid rescue may be adequate to prevent sequelae in patients who undergo intrathecal MTX overdoses up to 300 mg.
一名7岁急性淋巴细胞白血病（ALL）男孩在2小时内静脉注射了600毫克甲氨蝶呤（MTX），随后接受三联鞘内注射治疗（TIT），使用阿糖胞苷30毫克、甲泼尼龙10毫克和MTX 300毫克（而非规定的12毫克）。90分钟后，患者出现头痛、意识丧失和全身肌张力增高。他被转至重症监护病房，插管并接受苯巴比妥治疗。鞘内注射治疗3小时后，开始静脉注射左型亚叶酸（相当于消旋产品双倍剂量），每3小时100毫克，持续24小时，随后24小时每6小时注射一次。脑脊液检查结果正常。患者随后神经状态保持正常。我们病例中的良好结局表明，对于鞘内注射MTX过量达300毫克的患者，亚叶酸解救可能足以预防后遗症。
