Methotrexate overdose to a patient with ectopic pregnancy under medical management: A case of medication error, a preventable adverse event

5^th European Conference on Clinical and Medical Case Reports

September 07-08, 2017 Paris, France

Youssef Abo Elwan

Zagazig University, Egypt

Scientific Tracks Abstracts: J Clin Case Rep

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!! 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.

Biography :

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.