Many drugs (now it's known more than 1200) are associated with hepatic side effects. Children (especially newborns and infants) are unique population with specific characteristics of absorption, metabolism and elimination of drugs that can predispose to hepatotoxicity. Aim of this review is to estimate risk factors of hepatotoxicity related to the patients' peculiarities and drug itself, also to describe some mechanisms and types of drug-induced liver disease (DILD) and beside this to offer some methods of the treatment and prevention of hepatotoxicity. In children the most often mentioned drugs caused DILD are antibiotics, psychotropics and NSAIDs and the main type of DILD is acute hepatitis with mortality of 10%. To conclude it's highly important to monitor activity of hepatic enzymes (ALT, AST, AP) during treatment by potentially hepatotoxic drugs in patients from risk groups (early age, any liver disease, diabetes mellitus, obesity, poor nutritional status) in order to timely withdraw offending drug and prescribe hepatoprotectors or even perform liver transplantation.
Fever (t>38°C) developed in association with drug usage is rare but sometimes severe side effect (SE). It could manifest as single symptom or as a part of such life-threatening syndromes like malignant hyperthermia (MH), serotonin syndrome (SS), neuroleptic malignant syndrome (NMS). Fever could be caused by different therapeutic groups of drugs but the leading positions are occupied by antibiotics (mainly beta-lactams), substances acting on central nervous system (CNS) and chemotherapeutic agents. Main mechanisms are allergic and receptive. Curative measures include discontinuation of the suspected drug, introduction of agents blocking the action of the trigger factor -dantrolene (МН), bromocriptine (NMS), cyproheptadine (SS). Purpose of this review: to present the global and Russian data concerning fever as a drug-induced side effect. To distinguish the groups of patients and drugs of the highest risk. To evaluate aid measures. Results: fever as monosymptom of drug allergy is a difficult condition to be diagnosed and there are only few things that could help to recognize it such as temporal association with the suspected drug use and manifestation of fever along with the following resolution after suspected drug discontinuation and recurrence fever after suspected drug re-challenge. Among four syndromes described in this review such as serum sickness-like reaction (SSLR), NMS, SS and MH just fever at MH is not only a sign like in case of three others but it is significant and life-threatening manifestation and therefore requires additional curative methods (in addition to pharmacological support with dantrolene) -rapid cooling measures: ice-water nasogastric and rectal lavage, infusion of crystalloid solutions cooled up to 4°C, ice packs placing on main blood vessels and liver area, ventilatory measurements.
Drugs are common cause of renal damage -approximately 20% of out-patient and in-patient cases of acute renal failure are caused by drugs. The main reasons for this situation are the following: rapid growth of pharmaceutical market and therefore increased amount of drugs with known nephrotoxicity, aging of the population that is accompanied by the accumulation of such diseases like diabetes mellitus (DM), heart failure (HF), arterial hypertension (AH) following by the obligatory polypharmacy. On the other hand the achievements of contemporary medical science contribute to survivals of significant quantity of premature neonates with low and extremely low body weight. Thus the different types of pathological conditions like bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), sepsis, pneumonia, necrotic enterocolitis corresponding to such category of patients require aggressive treatment with off-label use. All factors listed above contribute to drug overload in the mentioned age-groups including drugs excreted by kidneys with possible damage of different renal structures and functions. The primary preventive measures could be the following: avoidance of the combination of drugs with known nephrotoxic effect, sufficient hydration and assessment of renal functioning using current biomarkers measuring before and in the progress of the treatment with potential nephrotoxic effect. It could be recommended the decreasing dose or interruption of the suspected drug in accordance with the deviation of parameters comparing to the baseline.
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