Background The first report, written by Sindey Farber in 1948, was successful in the use of methotrexate (MTX) for the treatment of leukemia in children. It was used for the first time in 1951 to treat rheumatoid arthritis (RA) and psoriasis. Methotrexate classical antifolate, also known as amethopterin, is 4-amino-4-deoxy-Na-methyl folic acid. The correlation between toxic reactions and the pharmacokinetics of methotrexate discloses certain time-and concentration-dependent relationships that appear to determine which target tissue is at risk for toxicity, whether toxicity will occur, and the severity of MTX toxicity. Results A high dose of MTX (HDMTX) is defined as more than 500 mg / m2 or if given intravenously. HDMTX results in toxicity, including hepatotoxicity, myelosuppression, and mucositis, and, in severe cases, may cause multiorgan failure. Conclusion An early understanding of the causes and risk factors for MTX toxicity may be beneficial in reducing the occurrence of MTX toxicity in the Taif region.

Methanol poisoning is a challenging issue due to its inducing acute multiple organ failures, and especially due to a lack of preparedness, available antidotes, and management protocols. The current study presents six cases of methanol poisoning that attended the emergency department of King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, between March and November 2022. All of the patients suffered from severe metabolic acidosis and visual impairment following the ingestion of homemade alcoholic beverages and colonia. Three patients were comatose, suffered from post-cardiac pulmonary arrest, and, finally, died, while the other three were non-comatose and discharged from the ICU after improvement. Management was based on clinical symptoms and other laboratory findings due to a shortage of methanol level measurement resources. The antidote, fomepizole, was not given to all of the cases due to its deficiency, and ethanol was given only to one patient due to difficulties in administering it without monitoring its concentration. Methanol poisoning and its outbreak provide insights into the dangers of hazardous homemade alcohol and other pharmaceutical preparations that might be adulterated with methanol, particularly to the shortage of suitable diagnostic testing and antidotes in addition to poor resources for management of intoxicated patients in some regions of Saudi Arabia.