Booklet for Hemato-Oncologists
Case 17 (A, B) - Erroneous introduction of 300 mg of MTX during triple intrathecal therapy
A 7-year-old boy with ALL received 600 mg of i.v. MTX over 2 hours followed by triple intrathecal therapy (TIT): Ara-C 30 mg, Methylprednisolone 10 mg and MTX 300 mg instead of the prescribed 12 mg. He was transferred to the ICU, intubated and treated with phenobarbital.
A - Which of the following rescue treatments, as management of IT-MTX overdose, is appropriate?
1. CSF exchange
2. i.v. folinic acid + dexamethasone
3. Glucarpidase IT + dexamethasone iv
4. Glucosaline infusion
5. Ventriculo-lumbar perfusion
B - Which exams have to be performed for his follow-up?
1. EEG + CT/MR scan + CSF
2. EKG + Echocardiography
3. Chest X-ray
4. CT/MR scan + fundus oculi
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