A 2 years old child without fever develps bone pain, vomiting and features of increased intracranial pressure following excessive medication. The drug most likely to be responsible for this is?
## **Core Concept**
The question revolves around the identification of a drug that can cause symptoms such as bone pain, vomiting, and increased intracranial pressure in a child without fever, following excessive medication. This scenario suggests a condition known as **Leukemia** or more specifically, **Methotrexate** toxicity or another chemotherapeutic agent's side effect.
## **Why the Correct Answer is Right**
The correct answer, **Methotrexate**, is a chemotherapeutic agent and an antifolate drug used in the treatment of various cancers, including leukemia, and autoimmune diseases. Methotrexate toxicity can present with symptoms such as bone pain (due to bone marrow suppression), vomiting (due to gastrointestinal toxicity), and signs of increased intracranial pressure (pseudotumor cerebri). These symptoms align with the child's presentation. Methotrexate works by inhibiting dihydrofolate reductase (DHFR), an enzyme important for DNA synthesis and repair.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Although certain drugs can cause similar symptoms, without specifics, it's hard to directly refute. However, typical drugs causing increased intracranial pressure usually don't cause the full spectrum of bone pain and vomiting as primary side effects in this context.
- **Option B:** This option is not directly identifiable without specifics but generally wouldn't cause the exact constellation of symptoms described.
- **Option C:** Similarly, without specifics, it's challenging to directly address, but the combination of symptoms points more towards a chemotherapeutic agent like methotrexate.
## **Clinical Pearl / High-Yield Fact**
A critical point to remember is that **methotrexate** toxicity can be managed with **folinic acid (leucovorin)**, which is a form of folate that can bypass the inhibited enzyme and help mitigate the toxic effects on normal cells. Early recognition of methotrexate toxicity and prompt intervention are crucial.
## **Correct Answer:** .