Chan Winnie Kwai Yu, Hui Wun Fung
Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, SAR, China.
Pediatr Nephrol. 2016 Oct;31(10):1699-703. doi: 10.1007/s00467-016-3389-2. Epub 2016 Jun 22.
High-dose methotrexate therapy (HDMTX) is a common form of chemotherapy used in children with high-grade malignancy such as osteosarcoma. Treatment with HDMTX requires careful monitoring of drug levels with folinic acid (leucovorin) rescue therapy. Toxicity from methotrexate is not uncommon and sometimes causes significant morbidity and mortality.
CASE-DIAGNOSIS/TREATMENT: We report an 11-year-old child whose 24-h post-HDMTX serum level was 651.8 μmol/L (recommended level <20 μmol/L), which was complicated by septic shock and progressive renal and liver failure. As carboxypeptidase (glucarpidase) was not available locally, she was treated with the sequential use of charcoal hemoperfusion (CHP) and single-pass albumin dialysis (SPAD). The patient recovered without complications. Both liver and renal function recovered with no significant late sequelae.
CHP and SPAD are effective extracorporeal methods of removing methotrexate. They provide alternative treatment options for critical care nephrologists in the management of methotrexate toxicity.
大剂量甲氨蝶呤疗法（HDMTX）是用于骨肉瘤等高分级恶性肿瘤患儿的一种常见化疗方式。HDMTX治疗需要通过亚叶酸（甲酰四氢叶酸）解救疗法仔细监测药物水平。甲氨蝶呤的毒性并不罕见，有时会导致严重的发病和死亡。
病例诊断/治疗：我们报告一名11岁儿童，其HDMTX治疗后24小时血清水平为651.8 μmol/L（推荐水平<20 μmol/L），并发感染性休克及进行性肝肾衰竭。由于当地没有羧肽酶（葡糖醛酸酶），她先后接受了炭肾血液灌注（CHP）和单次通过白蛋白透析（SPAD）治疗。患者康复且无并发症。肝功能和肾功能均恢复，无明显晚期后遗症。
CHP和SPAD是清除甲氨蝶呤的有效体外方法。它们为重症监护肾病专家处理甲氨蝶呤毒性提供了替代治疗选择。
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