PEDIATRIC CASE OF ACCIDENTAL ORAL OVER DOSE OF METHOTREXATE. Mohammed Almadan, Hedayah Hodayah and Ghufran Hodyah

Mohammed Almadan, Hedayah Hodayah and Ghufran Hodyah. Pediatrics Department, King Fahad of The University Hospital, Khobar,Kingdomof Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

We present the second youngest reported case of a single oral overdose of methotrexate inotherwise well 19 month sold child. Initialhistory revealed possibleingestion of 10 tablets, eachcontaining 2.5 mg. The peakmethotrexate levelwas. 92mmol/L measured8 hourfollowingingestion.
She appeared wellandalertwith normal observation .
This diversity can, be linked to some extent to the sequence of variations in genes involved in drug absorption, metabolism, excretion, cellular transport, and effector targets or target pathways.
The physical side effects of MTX in children are the sameasinadults, though childrengenerallytolerate MTXwell (8) ."Themost commonside effectsinvolve the gastrointestinaltract, including nausea and vomiting, transient elevation of liver-associated liver enzyme levels, usually occurringwithinthe first 24 hours. Mostcasesare mild , cause nosymptoms, resolve within7 to 10 days, andresult in no permanent liver damage.
In case series of mainlyadultoral overdoses of methotrexatethere wereno adverseoutcomes in patients where folinicacid rescuewas withheld; however , there isno information regarding ingested amounts or serum methotrexateconcentrationsand istherefore oflimited value.
In the context of MTX poisoning Luecovorinisgivenwithinatimeperiod of4 hours of the overdose with most of itstherapeutic effectiveness occurringwithinthe first hour of the overdose .Moreover,Theinitialdoseshould beequal or greater than maximumpossible doseofMTXingested. 1147 The favourable outcomeseen inour patient despite delayedfolinicacid rescuebrings into question the urgencyandthelevelof treatment required followingasingle oraloverdose of methotrexate .Lowto moderate levelofMTXand the limited time of exposure following single oraloverdose of MTX may contribute to the benignoutcomeinthiscase.
There is probablyinsufficient data in children at the current time to avoid intravenousleucovorintherapyandmonitoring for toxicside effects. However ,Supportive care and observation only should be considered the mainstay of treatment . (6)