Methotrexate Overdose To A Patient With Ectopic Pregnancy Under Medical Management: A Case Of Medication Error, A Preventable Adverse Event | 72780
Journal of Clinical Case Reports
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A 25-year-old female patient admitted via ER to Gynecology Ward. She was G2P0+1 with history of 5 weeks amenorrhea,
complaining from mild PV bleeding since a day before admission. There was a history of previous ectopic treated by Laparoscopy.
The patient was vitally stable. On examination, the abdomen soft, lax PV with OS closed with mild bleeding. Her CBC and blood
chemistry was within normal range. Pregnancy test (in ER) was positive, her B-hcg was1088. TVS, shows empty cavity, left adnexal
mass, pouch of Douglas free. Plan of management was medical treatment by methotrexate 50 mg IM stat with serial repeating B-hcg
after counseling the patient and her husband. The patient received 500 mg IM instead of 50 mg IM!! Immediately, blood sample was
taken and sent to toxicology center to determine serum methorexate level, CBC, LFT RFT. Plan of management is as follows: Calcium
folate leucovorine as 15 mg per amule/6 h iv, normal saline 500ml plus sodium bicarbonate 8.4% 90 ml to be 20 cc/h by infusion
bump, normal saline 500 ml/ h to keep urine PH>7, repeat CBC, RFT, LFT daily, serial serum level of methotrexate in toxicology
center and close observation. Methotrexate serum level before starting antidote was 85 (toxic level 24 hours after injection >5 mol/ L).
Serum levels of methotrexate start to decrease daily. All other investigations came within normal and the patient discharged in good
condition with follow up in OPD after one week. The case discussed in sentinel event committee and a policy of administration of
this cytotoxic drug implemented. In conclusion, patient life saved from toxic effect of methotrexate by rapid antidote of leucovorine
and hydration of the patient. Multidisciplinary input is of paramount importance.
Youssef Abo Elwan completed his M.D in the field of Ob/ Gyn in 1994 from Zagazig University, Egypt. He also completed his MRCOG from Royal College in London in 2008. Currently he works as Professor of Obstetrics & Gynecology under Faculty of Medicine, at Zagazig University. He is also the head of High Risk Pregnancy Unite and member of high council supreme for professor promotion in Egyption Universities.
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