Journal of Clinical Toxicology
Open Access

Darko Mitrovic

Publications

• Case Report
  Treatment of High Dose Methotrexate Toxicity with Glucarpidase
  Author(s): Darko Mitrovic, Daan J. Touw and W. Tissing Darko Mitrovic, Daan J. Touw and W. Tissing
  
  High Dose Methotrexate (HD-MTX) toxicity can cause renal dysfunction in patients due to a presence of risk factors such as body mass index >25 kg/m2, comedication (salicylates, NSAID`s, sulfonamides, beta-lactam antibiotics, aminoglycosides), urine pH<7, iv fluid intake <3 l/m2/24 hours, hepatic dysfunction, renal insufficiency prior to HD-MTX, diarrhea and pleural effusions. To prevent renal dysfunction and further MTX toxicity Glucarpidase can be used which degrades MTX to its metabolites. Cases: A 17 year-old and a 14 year-old boy were treated with HD-MTX, developed renal insufficiency and were treated with Glucarpidase. In both patients unexpected renal dysfunction was seen still 3-4 weeks after treatment with Glucarpidase. A theoretic concern regarding the use of Glucarpidase is that the rapid formation of MTX metabolite called DAMPA, which is almost 10-fold less soluble.. View More»
  DOI: 10.4172/2161-0495.1000293

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