Youssef Abo Elwan
Hera General Hospital, Saudi Arabia
Title: "Methotrexate overdose to a patient with ectopic pregnancy under medical management: A case of medication error, a preventable adverse event "
Biography
Biography: Youssef Abo Elwan
Abstract
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 !!
Imediately, Blood samle taken and send to Toxocology Center to determine serum Methorexate level, CBC, LFT RFT.
Plan of management was as follows :
1. Calcium Folate " Leucovorine" as 15mg per amule/6 h iv.
2. Normal Saline 500ml +Sodium bicarbonate 8.4% 90 ml to be 20 cc/h by infusion bump.
3. Normal Saline 500 ml/ h to keep urine PH>7.
4. Repeat CBC, RFT, LFT Daily.
5. Serial Serum level of Methotrexate in Toxocology Center.
6. Close Observation.
Methotrexate Serum level before starting Antidote was 85 ( Toxic level 24 hours after injection >5 mol/ L). Serum level 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 Adminsteration of these 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.