An overdose of vincristine in an eleven-year-old boy

Abstract

An eleven-year-old boy was given 15 rag of vincristine intravenously (0.6 mg/kg) instead of 1.5 mg. The cause of the mistake was a decimal error. Rescue therapy was started immediately, but still the boy developed most of the published toxic effects of vincristine overdosage. Rescue treatment included prophylactical platelet transfusions, whole blood transfusions, folinic acid, steroids, anticonvulsive and antihypertensive drugs, and antibiotics. Signs of a SIADH syndrome developed on the fourth day, but were controlled by water restriction. The boy slowly improved and, three weeks after the overdose, recovered completely. He died of his tumour one year after the overdosage, in spite of irradiation and further treatment with other cytostatics. Only three comparable cases have been published; two of these cases died, both of excessive haemorrhage. It is important to monitor coagulation factors closely and to give platelet transfusions as soon as the platelet count begins to fall. Whether folinic acid contributed to the relatively benign course of the overdose in the reported patient is impossible to evaluate.

Key Words:

• Overdose
• vincristine