A 25-year-old man receiving ifosfamide-based chemotherapy for osteosarcoma becomes confused and hallucinating on day 2 of infusion, progressing to mutism. The most appropriate treatment for this encephalopathy is:

• A Methylene blue ✓
• B Flumazenil
• C Naloxone
• D Mesna

Explanation

Ifosfamide metabolites, particularly chloroacetaldehyde, inhibit mitochondrial oxidative enzymes including complex I, producing encephalopathy ranging from somnolence to coma. Methylene blue acts as an alternative electron carrier in the mitochondrial electron transport chain and is the accepted treatment and prophylactic agent. Mesna prevents hemorrhagic cystitis only and does nothing for central nervous system toxicity, while naloxone and flumazenil address opioid and benzodiazepine overdose.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.