Massive Intrathecal Overdose: “Check the Label Twice!”

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Abstract
First developed for the treatment of childhood leukemia, intrathecal chemotherapy has been used with increasing frequency to treat many cancers of adulthood in which spread to the meninges occurs. Intrathecal administration provides an effective means of achieving therapeutic concentrations of selected anticancer agents in cerebrospinal fluid, because this route bypasses the blood–brain barrier, which normally restricts the Central-nervous-system penetration of most systemically administered drugs.1 Intrathecal chemotherapy is almost always administered by the intralumbar route. After intrathecal injection of a drug, the intitial volume of distribution is relatively small (approximately 140 ml for cerebrospinal fluid vs. approximately 5000 ml for blood); . . .