PMC9637359_01
Time course of plasma methotrexate concentrations (A) and medications and liver/renal function (B).
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Her 24-hour and 28-hour MTX levels were 224.64 and 181.4 mumol/L, respectively (Figure 1A). The girl developed acute kidney injury (AKI) with an increasing serum creatinine level of 197 mumol/L (Figure 1B). She also suffered from acute liver failure with prothrombin activity less than 40%, an increased ALT and AST levels (1247 U/L and 823 U/L, respectively, Figure 1B). After a total of 5 days for CVVHDF, serum ALT and AST levels were decreased to 285 U/L and 30 U/L, respectively, and the serum creatinine level was 79.9 mumol/L (Figure 1B). Over the following hospital days, her MTX level decreased very slowly and finally reached to 0.28 mumol/L after 14 days of high-dose leucovor in rescue (Figure 1A). After 3 days, the MTX level was decreased to 0.22 mumol/L (Figure 1A).