Department of Pediatrics.
Divisions of Pediatric Critical Care.
J Pediatr Hematol Oncol. 2022 Mar 1;44(2):e512-e513. doi: 10.1097/MPH.0000000000002366.
Methotrexate (MTX) is used in the treatment of several childhood cancers and is a main component of the treatment regimen for osteosarcoma. MTX has been linked with side effects of varying severity; headaches, nausea, emesis, lethargy, blurred vision, aphasia, hemiparesis, paresis, convulsions, leukoencephalopathy, and arachnoiditis are symptoms of MTX toxicity. MTX-induced neurotoxicity can occur in up to 15% of patients receiving high-dose MTX. The effects may be transient but can have life-threatening implications, sometimes requiring intubation for respiratory support and airway protection. Elevated homocysteine levels in the cerebrospinal fluid are documented in cases of MTX-induced neurotoxicity; dextromethorphan is used as an initial treatment for MTX-induced neurotoxicity as it works as a noncompetitive antagonist for the N-methyl D-aspartate receptors and suppresses homocysteine activity. In severe cases requiring intubation, medications for sedation are utilized. Ketamine is also an N-methyl D-aspartate receptor antagonist, and as such, may be considered as an optimal treatment choice when sedation is required. We describe the use of ketamine in a pediatric patient with MTX-induced neurotoxicity. The use of ketamine in the treatment of MTX-induced neurotoxicity has not been described in the literature.
甲氨蝶呤（MTX）用于治疗多种儿童癌症，也是骨肉瘤治疗方案的主要组成部分。MTX 与不同严重程度的副作用有关；头痛、恶心、呕吐、嗜睡、视力模糊、失语、偏瘫、轻瘫、抽搐、脑白质病和蛛网膜炎是 MTX 毒性的症状。高达 15%接受高剂量 MTX 的患者可能会发生 MTX 诱导的神经毒性。这些影响可能是暂时的，但可能具有危及生命的意义，有时需要插管进行呼吸支持和气道保护。在 MTX 诱导的神经毒性病例中，脑脊液中同型半胱氨酸水平升高；右美沙芬被用作 MTX 诱导的神经毒性的初始治疗，因为它作为 N-甲基-D-天冬氨酸受体的非竞争性拮抗剂起作用，并抑制同型半胱氨酸的活性。在需要插管的严重情况下，使用镇静药物。氯胺酮也是一种 N-甲基-D-天冬氨酸受体拮抗剂，因此，在需要镇静时，它可能被视为最佳治疗选择。我们描述了氯胺酮在一名患有 MTX 诱导的神经毒性的儿科患者中的使用。氯胺酮在治疗 MTX 诱导的神经毒性中的应用尚未在文献中描述。
