Blood purification therapies of hypermethotrexemia / 中国小儿急救医学

ABSTRACT

Methotrexate ( MTX) is administered at a high dose for the treatment of diseases such as leukemia and malignant lymphoma. However, it will cause serious adverse reactions such as acute kidney injury,myelosuppression, and mucositis. On the basis of hydration alkalization and high-dose leucovorin rescue in children with high risk of MTX poisoning,blood purification should be performed as soon as possi-ble to clear MTX. The number and frequency of hemodialysis should be determined according to the general condition of the child,the degree of renal injury and the concentration of MTX,and high-throughput hemodi-alysis can be selected if available. Continuous renal replacement therapy is suitable for children with hemodynamic instability. When the MTX concentration is extremely high, it is recommended to combine hemoperfusion and hemodialysis to achieve better clearance.