BACKGROUND Data is limited on comparison of acute and chronic methotrexate (MTX) poisoning. Methotrexate is an anti-folate drug that may be prescribed in some malignant or chronic inflammatory conditions. The aim of the current study was to compare signs and symptoms, complications, treatment and final outcome of acute and chronic MTX toxicity. METHOD In a retrospective study in a referral center between March 2010 and March 2018, all patients who had been referred with the history of MTX poisoning and hospitalized due to acute or chronic poisoning were evaluated and compared. RESULTS Of the total 27 patients admitted during the study period, 13 had referred with acute (group 1; consumption of MTX for less than 7 days) and 14 had referred with chronic toxicity (group 2; consumption of MTX for more than 7 days). Mean age was significantly higher in the second group (P < 0.001). Median total dose of MTX was similar between the groups (P = 0.90). Mucosal ulcers and skin lesions (P < 0.001 and 0.02, respectively) were the only symptoms significantly different between the two groups. Leukopenia (P < 0.001), thrombocytopenia (P < 0.001), and anemia (P = 0.04) were significantly more common in the second group. Blood urea nitrogen and creatinine were also significantly higher in the second group of the patients (P < 0.001 and P = 0.048). Median leucovorin administered dose was 200 mg [14, 480] versus 150 mg [75, 187] (P = 0.69) in groups 1 and 2, respectively. CONCLUSIONS Chronic MTX poisoning is more serious than acute toxicity and accompanies higher dermatologic, hematologic, and hepatic complications necessitating more aggressive treatments including administration of higher doses of leucovorin or bone marrow stimulants such as G-CSF. This may be attributable to the underlying diseases and features (including older ages) which predispose these patients to complications.

中文翻译：

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急性与慢性甲氨蝶呤中毒；横断面研究。

背景技术数据在比较急性和慢性甲氨蝶呤（MTX）中毒方面是有限的。甲氨蝶呤是一种抗叶酸药物，可能在某些恶性或慢性炎症性疾病中开出处方。本研究的目的是比较急性和慢性MTX毒性的体征和症状，并发症，治疗和最终结果。方法在2010年3月至2018年3月之间的转诊中心进行的一项回顾性研究中，对所有因MTX中毒病史而转诊并因急性或慢性中毒而住院的患者进行了评估和比较。结果在研究期间共入院的27例患者中，有13例转诊为急性（第1组；服用MTX少于7天），有14例转诊为慢性毒性（第2组；服用MTX超过7天）。 。第二组的平均年龄明显更高（P <0.001）。两组间MTX的中位总剂量相似（P = 0.90）。两组之间唯一的症状是粘膜溃疡和皮肤病变（分别为P <0.001和0.02）。在第二组中，白细胞减少症（P <0.001），血小板减少症（P <0.001）和贫血（P = 0.04）更为常见。第二组患者的血尿素氮和肌酐也显着较高（P <0.001和P = 0.048）。第1组和第2组中，亚叶酸钙的中位剂量分别为200 mg [14，480]和150 mg [75，187]（P = 0.69）。结论慢性MTX中毒比急性毒性更严重，并伴有更高的皮肤病学，血液学，肝脏并发症需要更积极的治疗，包括给予更高剂量的亚叶酸钙或骨髓刺激剂（例如G-CSF）。这可能归因于潜在的疾病和特征（包括年龄较大），这些疾病和特征使这些患者容易发生并发症。