[Clinical manifestation, diagnosis and treatment of rare forms of acute drug poisoning (lecture)].
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Biomedical subjects
Publications and source records attributed to Iu S Gol'dfarb.
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Information, toxicometry and detoxication are most important problems of clinical toxicology today because exchange of information perfect the skill of toxicologist in diagnosis and choice of treatment, whereas measurement of the toxic factor, blood poison concentrations enables systemic computer analysis of critical conditions caused by poisonings. Treatment of acute poisoning produces the highest effect if detoxication method is used including blood detoxication by sorption-dialysis methods and intestinal lavage in combination with physiohemotherapy. This approach provides a rapid elimination of poison from the body and effective correction of homeostasis.
An original technique of magnetic hemotherapy has been tried in 110 patients with severe exogenic poisoning. The addition of the above hemotherapy raised the efficacy of combined detoxication due to correction of hemorheological and stabilization of hemodynamic parameters as indicated by diminished endotoxicosis, reduced lethality, prevention of somatic complications which when available became less severe.
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Physical factors (magnetic fields and UV and laser exposure) improve the blood status and sodium hypochlorite therapy accelerates removal of exo- and endogenic toxic substances from the organism, as was demonstrated in more than 1200 patients with various intoxications. These effects are due to activation of the detoxication systems of the organism and more rapid removal of some toxic agents from the blood during hemoperfusion. Adequate dosing of these exposures by means of clinical dosimetry will improve the efficacy and safety of detoxication.
Study of the relationship between activated charcoal potential and its effects and the biological media and organic toxic agents is in progress. Using the electrochemical model of hemoperfusion proposed previously, the authors defined the optimal conditions for modifying the hemoadsorbents from activated charcoal, carried out monitored hemoperfusion detoxication in patients, and improved the results of treatment in patients with acute poisonings with organophosphorus compounds, psychotropic and soporific agents, and with 1,2-dichloroethane.
Serotonin adipinate in a dose of 40-60 mg was injected by drip infusion to 30 patients with acute poisoning by psychotropic drugs for correcting circulatory disorders. The drug corrected hemodynamic disorders in the lesser and greater circulation by increasing the stroke volume and normalizing total peripheral vascular resistance and central blood volume.
Progress in clinical toxicology implies search for new approaches to improving the intensity of urgent detoxication in patients with acute poisoning by stimulating the natural cleansing of the organism, improving complex detoxication as part of adsorption, dialysis filtration, apheretic, and physiohemotherapeutic procedures, and creation of new specific (antidote) drugs). Progress in clinical diagnosis requires further research of new types of acute poisoning and the endotoxicosis syndrome and development of information and consultation service for such cases.
Experience gained in the treatment of more than 750 patients with acute poisoning complicated by endotoxicosis showed that the entire complex of typical changes in endotoxicosis markers and homeostasis parameters (hematological, immunological, hemorheological, LPO/AOD) should be taken into consideration during the diagnostic studies. These shifts should be timely corrected by the basic efferent methods of artificial detoxication (hemosorption, hemodiafiltration, hemofiltration) with obligatory physio- and chemohemotherapy (laser-UV hemotherapy, infusion of sodium hypochlorite).
The study of these intoxications has demonstrated that the blood level of methemoglobin (MH) is in conformity with the severity of intoxication. The pathospecific therapeutic effect of sodium hypochlorite (SHC) in acute intoxications of varying severity has been found to appear as a significant intensification of demethemoglobinization and as a three-fold reduction in the half-life of MH. The nonspecific effect of SHC manifests itself in correcting metabolic acidosis and in improving blood oxygenation. The use of SHC accelerates the regression of clinical manifestations of disease and reduces the length of inpatient treatment.
Platelet nitric oxide production has been investigated in patients with thoracic and abdominal wounds, thermal trauma, varicose disease, methanol and leponex poisoning. There is correlation between absolute platelets nitric oxide production and fibrinogen plasma level in these patients. The maximal absolute platelets nitric oxide production has been revealed at surgical diseases, and minimal has been observed at methanol poisoning. Irrespectively to etiology and danger of disease, reliable correlation between absolute platelets nitric oxide production and fibrinogen plasma level of these patients is established. Consequently platelets nitric oxide production may be important for haemostatic processes.