Cerebellar herniation after intrathecal chemotherapy including cytosine arabinoside in a boy with T acute lymphoblastic leukemia

Accidental Overdose of Intrathecal Cytarabine in Children

“…26 However, because of toxicity concerns, most trials do not prescribe intrathecal cytarabine doses greater than 100 mg. 26 When administered parenterally, cytarabine readily crosses the blood-brain barrier and its movement out of the CNS is correlated with the CSF bulk flow rate. 16,27 Therefore, toxicity from cytarabine may be more likely when CSF flow is obstructed. 27 The absence of adverse symptoms in our 2 patients may be attributed to the short terminal half-life of intrathecal cytarabine, the absence of CSF obstruction, and individual variations in drug metabolism and CSF dynamics.…”

“…16,27 Therefore, toxicity from cytarabine may be more likely when CSF flow is obstructed. 27 The absence of adverse symptoms in our 2 patients may be attributed to the short terminal half-life of intrathecal cytarabine, the absence of CSF obstruction, and individual variations in drug metabolism and CSF dynamics. 16 Most medication errors result from faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.…”

Safety of inadvertent administration of overdose of intrathecal Cytarabine in a pediatric patient

“…13 However, medication errors in preparation of IT chemotherapy are not uncommon and can lead to significant toxicities. 4,10–16…”

“…6,9,13,17–19 Presence of CSF obstruction was also mentioned to be a contributing factor to morbidity. 10 The IV formulation of Cytarabine is a preservative free compound; so, theoretically substituting an IV formulation for the IT one is generally safe. 20…”

“…[3][4][5] Toxicities following administration of IT Cytarabine have been described in the literature. [4][5][6][7][8][9][10] Neurotoxicity is the most commonly described side effect. It may present as lethargy, seizures, myelopathy or encephalopathy with some reported cases of irreversible damage.…”