Abstract
A 45-year-old woman underwent surgery for osteosarcoma. High-dose methotrexate (MTX) therapy was started during the post operative period. She suddenly developed shock and loss of consciousness, after the 7th dose. She was immediately treated vcTith catecholamines and steroids. Although she recovered from shock, she developed acute renal failure (ARF). She was admitted to our ICU on the next day. to prevent the development of life-threatening complications due to MTX accumulation as a result of decreased renal clearance. Plasma MTX concentration was more than 50 times higher than the safety level at the time of her admission to the ICU. Clearance of MTX was carried out successfully by hemodialysis (20 times) and plasmadsorption (3 times). Massive leucovorin(R) rescue was performed simultaneously. Mild complications such as mental disturbance, hypoperistalsis, myelosuppression and mucositis were also observed. The complications gradually disappeared as the plasma MTX concentration decreased, and she was discharged from the ICU 18 days later. Hemodialysis and plasmadsorption. performed when he plasma MTX concentration were similar, on the 3rd day showed no singnificant difference in column clearance. Thus, we suggest that hemodialysis alone or with plasmadsorption may be an effective treatment for MTX-poisoning associated with ARF.
