Key investigations

Key investigations for suspected methotrexate poisoning should be performed on presentation to hospital in:

  • adults following deliberate self-poisoning
  • children who have accidentally ingested more than 5 mg/kg
  • patients with suspected repeated supratherapeutic ingestions.

Key investigations include:

  • serum electrolyte, urea and creatinine concentrations, and estimated glomerular filtration rate (eGFR)
  • full blood count
  • liver biochemistry.

Serum methotrexate concentration is not useful in the management of acute or repeated supratherapeutic methotrexate ingestions.