One 10-year-old boy was admitted to hospital for acute lymphoblastic leukemia for more than 2 months. After admission, high-dose methotrexate treatment regimen was administered for chemotherapy. Hydration, alkalization, antiemetic, hepatic protectants and calcium leucovorin were given for symptomatic therapy. On the second day of chemotherapy, the patient appeared poor appetite, nausea, frequent vomit, abdominal pain and diarrhea, headache, dizziness, joint pain and lumbar muscular pain. Clinical pharmacists participated in the whole treatment process. Through monitoring blood concentration of methotrexate and combining with state of the patient, delay excretion of methotrexate was considered to be the cause of the adverse reactions above. Clinical pharmacists proposed to continue antiemetic, increase the amount of hydration and alkalization, increase the calcium leucovorin dose and further monitor the plasma concentration of methotrexate in order to suit the remedy for the case. After the therapy, the patient was discharged with stable. The case suggested that blood concentration of methotrexate should be monitored when high-dose chemotherapy was used. We ought to adjust the dosage of calcium leucovorin according to the concentrations of methotrexate at 48 h and 72 h, in order to avoid the adverse drug reactions.%1例10岁的男性患儿,因"急性淋巴细胞白血病2个月余"入院,入院后给予大剂量甲氨蝶呤化疗,同时给予水化碱化、止吐、护肝和亚叶酸钙解救等对症治疗.化疗后第2天患儿出现精神食欲差、恶心、频繁呕吐、腹痛腹泻、头痛头晕、关节痛和腰部肌肉痛.药师给予患儿全程药学监护,根据甲氨蝶呤血清药物浓度,结合患者病情,考虑是甲氨蝶呤延迟排泄引起的不良反应.建议继续止吐、增加水化碱化量,及增加亚叶酸钙给药剂量,进一步监测甲氨蝶呤血药浓度等对症处理,对患者进行详细用药教育.患者病情平稳后出院.建议临床在使用大剂量甲氨蝶呤化疗时应密切监测患者血药浓度,根据48 h和72 h血药浓度调整亚叶酸钙的用量,以减少不良反应的发生.
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