ACUTE METHOTREXATE POISONING - SUCCESSFUL TREATMENT BY HEMODIALYSIS WITH ACTIVATED-CHARCOAL HEMOFILTRATION

Methotrexate (MTX) is often used in high doses to treat malignant pediatric diseases. Intratubular precipitation of MTX and its metabolites results in renal failure responsible for potentially life-threatening systemic accumulation of the drug. Prompt and effective dialysis is, therefore, the mainstay of treatment. Two patients (NL, 15 years ; EJ, 10 years) were treated for inadvertent MTX overdosage by haemodialysis with charcoal haemofiltration (HD + CHP). Both patients had transient renal failure with anuria. Plasma MTX levels fell from 52 to 4.8 mumol/L after four HD + CHP sessions in patient NL; in patient EJ, three HD+CHP sessions with peritoneal dialysis for eight days reduced plasma MTX levels from 612 to 0.5 mumol/L. Mean MTX extraction coefficients with HD+CHP were 65 % in NL and 71 % in EJ. Both patients had only mild systemic symptoms of drug toxicity and had virtually normal glomerular filtration rates after three and five years' follow-up for NL and EJ, respectively. These two cases demonstrate that haemodialysis with charcoal haemofiltration is effective in patients with acute methotrexate poisoning.