Evaluation of the efficacy of a succinate-containing drug in the treatment of acute poisoning with nonsteroidal anti-inflammatory drugs in children

The objective of this study was to evaluate the incidence of acute kidney injury and the effectiveness of succinates in the comprehensive treatment of acute poisoning with nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Patients and methods. Retrospective stage: an analysis was conducted of medical records for 2019–2023 for all patients hospitalized in the toxicology department of N.F.Filatov Children's City Hospital, Moscow with NSAID poisoning. Prospective stage: 38 children aged 11 to 18 years (mean age 14.9 years) with acute NSAID poisoning hospitalized in 2024 from January to December and constituting the main group receiving the succinate-containing drug Cytoflavin® as part of complex therapy were examined. We remember the chemical and toxicological examination, all patients underwent urine analysis, biochemical blood analysis, acid-base status of blood, and ultrasound examination of the kidneys with Doppler imaging of the renal vessels. The glomerular filtration rate was calculated using the Schwartz bedside formula (2009). The examination was performed on all patients on days 1 and 3 after poisoning, and in cases of acute kidney injury (AKI), additionally on days 5 and 7. In addition to standard detoxification therapy, all patients were prescribed an intravenous infusion of a cell succinate-containing drug at a daily dose of 20 ml, diluted in 100 ml of 5% glucose. The standard course of therapy was 5 days; if azotemia persisted on day 3, the dose was increased to 30 ml/day and the course was extended to 7 days. All patients tolerated the drug well without developing side effects. Statistical analysis of the research results was performed using the StatTech v.3.09 software package (developed by StatTech LLC, Russia). Results. In 2019, 59 children were treated in the toxicology department for NSAID poisoning, accounting for 15% of all drug intoxications, and in 2023, 213 children were hospitalized for NSAID poisoning, accounting for 35.6%. Most of the children were over 11 years old. Of the 38 children in the main group hospitalized in the toxicology department of N.F.Filatov Children's City Hospital, Moscow in 2024 with acute NSAID poisoning, in 30% of cases, an increase in serum creatinine and urea levels above the reference values was noted already on the first day of the disease. At the same time, children with elevated azotemia showed a tendency to decrease GFR to 70.7 [61.9; 117.5] ml/min/1.73 m2. Against the background of ongoing therapy, repeated biochemical blood tests were performed, which showed that in 22 (58%) children in the main group, serum creatinine and urea levels normalized. According to the KDIGO (2012) classification, stage 1 CKD developed in 9 (23.7%) children (serum creatinine levels were above 140 μmol/L [129.3; 161.1 μmol/L]), stage 2 AKI developed in 6 (15.8%) cases (creatinine levels ranged from 217 to 286 μmol/L [123.1; 186.7 μmol/L] and in one case (2.5%) there was stage 3 CKD, requiring renal replacement therapy (RRT). Increasing the dose of succinate-containing medication from 20 ml to 30 ml/day and extending the course from 5 to 7 days for patients with AKI contributed to the normalization of GFR to 117.9 [107.0; 151.0] ml/min/1.73 m2 and normalization of serum urea and creatinine levels. Conclusion. Our clinical observation showed that the use of a succinate-containing drug, including inosine + nicotinamide + riboflavin + succinic acid in the complex therapy of acute NSAIDs, administered intravenously slowly at a daily dose of 20 to 30 ml depending on the severity of renal dysfunction, has a positive effect in terms of reducing azotemia and normalizing GFR. Key words: acute kidney injury, children, poisoning with nonsteroidal anti-inflammatory drugs