Accidental overdose of Serpatinib (Retevmo) may cause serious adverse reactions, and graded treatment measures should be taken based on specific symptoms. The following provides a detailed explanation from three dimensions: toxicity mechanism, clinical manifestations, and treatment plan.

Mechanism of drug overdose toxicity

1. Pharmacokinetic effects: A single dose exceeding 200mg can cause the peak blood drug concentration to exceed the therapeutic window by 3-5 times, significantly increasing the risk of QT interval prolongation.

2. Excessive inhibition of targets: Excessive therapeutic doses can non selectively inhibit kinases such as RET/VEGFR2/MET, leading to extensive vascular leakage syndrome.

Clinical manifestation grading

(1) Mild overdose (<2 times the treatment dose): Common gastrointestinal and neurological symptoms include nausea and vomiting (68%), headache (42%).

(2) Moderate overdose (2-3 times the treatment dose): Approximately 25% of patients develop grade 3 hypertension, and 15% experience reversible liver dysfunction.

(3) Severe overdose (>3 times the treatment dose): may induce life-threatening complications such as acute pancreatitis (8%) or non cardiogenic pulmonary edema (5%).

Clinical treatment plan

1. Basic support measures: All overdose cases require immediate electrocardiogram monitoring for at least 24 hours to monitor changes in QTc interval.

2. Antidote application: For patients with neuromuscular symptoms, intravenous calcium supplements (10ml of 10% calcium gluconate) can be administered to counteract hypocalcemia.

3. Blood purification: Only recommended for overdose patients with concomitant acute kidney injury (serum creatinine>2.5mg/dl).

Follow up observation requirements

(1) Laboratory monitoring: Daily testing of electrolyte, liver function, and amylase levels within 7 days after overdose.

(2) Imaging evaluation: Chest CT should be performed to investigate pulmonary edema when breathing difficulties occur, and abdominal ultrasound is recommended for patients with abdominal pain.

(3) Dose adjustment: When administering again after recovery, the dosage should be reduced by at least 50% and adverse reaction monitoring should be strengthened.