Detoxification therapy drugs. Detoxification therapy of the body: preparations and solutions, cleansing methods

Which is aimed at cleansing the body and ridding it of the influence of various toxic substances that come from outside or are formed in it due to certain processes.

This treatment is used for endogenous intoxication, when metabolic products are not completely removed from it, as well as for various poisonings.

There are two types of poisoning for which detoxification therapy is prescribed:

• Intoxication is when the body reacts painfully to various poisons. This reaction is protective and is aimed at combating the effects of the toxin in the body.
• – a perverted, nonspecific immune response to the effects of viruses and microbial toxins. Toxicosis occurs due to too rapid transition of adaptive reactions into pathological ones.

How is detoxification therapy carried out?

There are two types of treatment for poisoning:

• Specific therapy involves the use of antidotes, immunotherapy and other options for antitoxic effects.
• Nonspecific methods include stimulating the activity of enzyme systems that provide metabolism and binding of poisons in the body, as well as restoring the normal functioning of internal organs involved in detoxification - kidneys, lungs, liver, gastrointestinal tract.

Depending on the nature of the effect on the body, there are two types of detoxification therapy:

• Intracorporeal – the removal of toxins is stimulated by therapeutic methods that involve the body’s natural excretory systems: the gastrointestinal tract, the urinary system.
• Extracorporeal - a number of methods that rid the body of poisons artificially, using various medications.

Intracorporeal exposure is usually prescribed. The second detoxification method is used only if the body is not able to cope with the increasing signs of poisoning on its own. Extracorporeal detoxification includes apheresis, filtration, dialysis, sorption, and electrochemical action on the blood.

Symptoms of intoxication include the following:

• change in skin color,
• disturbances in the functioning of the central nervous system - loss, clouding of consciousness, deterioration or intensification of psychomotor activity,
• malfunctions of the cardiovascular system - tachycardia, bradycardia, blood pressure surges,
• disturbances in the gastrointestinal tract - nausea, diarrhea, vomiting, intestinal paresis.

Because endogenous and exogenous factors can be involved in poisoning, two types of treatment are used in hospitals.

Etiotropic treatment

It is necessary for patients with severe viral infections. They are prescribed antiviral drugs, which often include immunoglobulins and other drugs.

For patients with bacterial infections, respectively, along with which they are given hyperimmune components. Among them are antitoxic serums, different types of plasma, and immunoglobulins. What kind of disinfection therapy will be for each individual patient depends on the clinical indicators of the course of his illness.

Pathogenetic treatment

It includes the following measures:

• hemodilution (blood dilution),
• elimination of hypoxia,
• restoration of blood circulation,
• supporting the work and restoration of detoxification organs.

Hemodilution reduces the concentration of poison in the blood, as well as in the intercellular space. Blood circulation is restored by introducing plasma substitutes and electrolytes. All types of hypoxia are eliminated through oxygenation, or oxygen therapy, which is carried out in special rooms. First of all, it is necessary to restore detoxification organs such as the kidneys and liver. To do this, the patient’s body is provided with plenty of water. The effectiveness of such therapy is determined by the hourly or daily volume of diuresis (urination).

Infusion detoxification therapy

To put it simply, these are droppers with a glucose-saline solution. The most common glucose to salt ratio is 1:1 or 2:1. The mode of fluid administration depends on the degree of intoxication:

• in the first degree, half the volume is administered over 2-3 hours,
• in the second degree, the required volume is administered over 4-6 hours, adding plasma-replenishing liquid to it,
• in the third degree, up to 90% of the volume is administered throughout the day; based on the patient’s condition, this therapy can be continued.

Such detoxification of the body can be carried out at home under the supervision of a doctor. Often this procedure is required for alcohol and drug addicts who do not want to go to the hospital. Although their condition will improve after they undergo a course of IV drips, such detoxification therapy is not a cure in itself. Poisons could trigger pathological processes in the body, so the patient must not only get rid of addiction, but also undergo a comprehensive medical examination.

If the intoxication is very severe, the method of forced diuresis is used. These are the same droppers with glucose-saline solution, plus strong diuretics. Forced diuresis is often used for older children who exhibit symptoms of severe poisoning. If possible, such therapy includes an oral water load, giving the child special solutions - mixtures of electrolytes. Sometimes it is necessary to include hemodilution using blood substitutes.

Forced diuresis should not be used when intoxication is complicated by chronic or acute heart failure or impaired renal function.

Preparations for detoxification of the body

To enhance the effect of any action aimed at ridding the body of toxins, the following drugs are used:

• with a targeted cleansing effect,
• various enterosorbents,
• hepatoprotectors,
• antispasmodics,
• chole-, enterokinetics and others.

And finally, I would like to discuss a little home detox methods when people decide to cleanse the body on their own. This cannot be called detoxification therapy, but such actions should be carried out only after consultation with a doctor. Some drug complexes and detox diets can seriously undermine your health.

For example, there is a legend on the Internet that taking activated carbon in large doses promotes detoxification and weight loss. A side effect of such self-medication can be prolonged constipation and ulcerative formations on the walls of the stomach.

If food poisoning occurs, you should rinse your stomach and immediately take sorbents. Next, the doctor, based on the patient’s condition, will prescribe suitable detoxification therapy. When intoxication or toxicosis is expressed by strong clinical manifestations, hospitalization, detailed examination and, possibly, the appointment of extracorporeal detoxification therapy are necessary.

DISINTOXIFICATION AND GENERAL STRENGTHENING THERAPY

In the fight against purulent infection in acute odontogenic inflammatory diseases, measures aimed at combating intoxication, increasing the general reactivity of the body and its nonspecific resistance are of great importance.

In acute purulent-inflammatory diseases of the maxillofacial area, due to malnutrition, the patient’s body can lose a huge amount of proteins, salts, water and vitamins. An important point in the development of metabolic disorders is a disruption of the process of albumin synthesis in the liver. Hypoalbuminemia in patients with purulent-septic complications develops with a sharp increase in globulin fractions. The increase in the level of globulins occurs due to the α- and β-fractions, and the level of γ-globulins remains low. When protein metabolism is disturbed, dysproteinemia often occurs. The term “dysproteinemia” is proposed to denote the whole variety of disturbances in the quantitative ratios of protein fractions. Among serum proteins, albumins have the smallest molecular size and the smallest molecular weight. With abscesses and phlegmon of the face and neck, hypoalbuminemia quickly develops. Its occurrence is due to impaired tissue nutrition, intoxication of the body, decreased synthesis of albumin in the liver, and impaired vascular permeability (albumin leaves the vascular bed along with the fluid). A decrease in the albumin-globulin coefficient indicates significant intoxication of the body, and its increase indicates a decrease in toxemia and an improvement in the general condition of the patient.

In the body of a healthy person, the content of amino acids in the blood is in dynamic equilibrium with cell proteins. The content of proteins and amino acids in the blood serum reflects the degree of saturation of the entire body with proteins, and their low concentration in the blood is regarded as an indicator of depletion of protein reserves of the liver and other tissues. In pathological processes, there is often a time gap (5-6 hours) between the absorption of essential amino acids. The amino acids that are absorbed first are already leaving the bloodstream, while the amino acids that are absorbed last are just entering there. The full set of amino acids required for protein synthesis is not created. Amino acid deficiency in protein deficiency is aggravated by impaired protein biosynthesis. Changes in the amino acid composition of the blood in patients with purulent-inflammatory diseases of the maxillofacial area were noted by D. I. Shcherbatyuk, M. Ya. Anestiyadi, S. V. Latyshev and co-authors, etc.

Studies conducted by V. S. Starodubtsev and co-authors indicate changes in the content of potassium and sodium in serum, red blood cells, and also in urine in patients with acute odontogenic processes. We support the opinion that in patients with severe and moderate inflammatory diseases, it is advisable to correct the electrolyte balance not only in the postoperative, but also in the preoperative period.

When carrying out detoxification therapy, one should take into account the possibility of increasing blood toxicity when administering rheopolyglucin, since improving microcirculation leads to the leaching of toxic products from tissues and their accumulation in the blood. Therefore, subsequent administration of hemodesis is indicated. The mechanism of the detoxifying effect of the drug is based on the ability to bind toxins and quickly remove them through the kidneys. This is possible due to its property of increasing renal blood flow, quickly passing through the renal barrier, increasing glomerular filtration and increasing diuresis. The introduction of hemodesis does not cause complications. If the infusion rate is exceeded (more than 60 drops per minute), a drop in blood pressure may occur. In these cases, they resort to the introduction of vasoconstrictors and cardiac drugs. Hemodez is administered in 200-400 ml doses at a rate of 40-60 drops per minute. Its repeated administration is carried out after 12 hours. Its single administration can reduce blood toxicity by 1.5-2 times. This effect lasts for 10-12 hours, after which repeated administration of the drug is recommended.

In addition to rheopolyglucin and hemodez, it is advisable to administer 5-10% glucose solutions in an amount of 500-1000 ml with insulin (1 IU of insulin per 5 grams of glucose), which has a detoxifying effect and is an additional source of energy. Its administration should be combined with intravenous administration of isotonic fluids (isotonic sodium chloride solution - 500 ml, 5% sodium bicarbonate solution - 200-300 ml, etc.). Intravenous administration of blood substitutes must be combined with the administration of proteinase inhibitors (contrical), broad-spectrum antibiotics (pentrexil, kefzol, cefamizine, etc.), ascorbic acid and B vitamins, hyposensitizing and antipyretic drugs.

An important point in detoxification in severe purulent-inflammatory diseases of the face and neck is forced diuresis. It is based on the use of the natural process of removing toxic substances from the body through the kidneys due to their concentration and excretory function. The patient receives 3000-5000 ml of fluid and excretes 3000-4000 ml of urine. Hourly recording of the amount of fluid administered and urine excreted is carried out. For the purpose of forced diuresis, mannitol is administered - 1 - 1.5 kg / patient's body weight - or lasix - 40-80 mg. The effect of the latter is potentiated by a 24% solution of aminophylline (10 ml of aminophylline is administered in 20 ml of a 20% glucose solution).

For patients with severe hypovolemia, it is recommended to prescribe protein blood products: 10-20% albumin solution (200 ml), protein (250 ml) or plasma (200-300 ml). They have a stimulating effect on the excretory, neuroendocrine and hematopoietic functions of the body, and are also able to remove toxic products from the body.

In our clinic, hemodilution is successfully used as a therapeutic measure in patients with various phlegmons of odontogenic origin. In recent years, hemosorption is a method of removing toxins from the body by extracorporeal blood perfusion through granular or plate sorbents. We used this method in severe patients with acute purulent-inflammatory processes of the face and neck. A positive effect was obtained.

To treat hemocoagulation disorders, heparin is administered intramuscularly at a dose of 5,000-10,000 units every 4 hours. Heparin is administered under the control of blood clotting time (every 8 hours). Its lengthening by 2 times compared to the initial time indicates adequate anticoagulant therapy. L. M. Tsepov recommends treatment with heparin for 3-5 days, then reducing its dosage and switching to indirect-acting anticoagulants (neodecoumarin on the first day 0.2 g 3 times a day, on the 2nd day - 0.15 g 3 times a day, and then 0.2-0.1 g once a day). Direct and indirect anticoagulants are prescribed together for 1-2 days. The antagonist of heparin is protamine sulfate. It is administered intravenously at 5 ml of a 1% solution per 10,000 units of heparin. Repeated administration is possible after 15-20 minutes. Antagonists of indirect anticoagulants are vikasol (0.3% solution of vikasol, 5 ml 3 times a day intramuscularly), ascorbic acid, calcium chloride. To reduce capillary toxicity, simultaneous intake of rutin and vitamin P is recommended.

Contraindications to the use of anticoagulants may include acute and chronic leukemia, increased vascular permeability, hypovitaminosis K and C, gastric and duodenal ulcers, subacute endocarditis, hypertension, malignant neoplasms, hemorrhoidal and uterine bleeding, severe liver and kidney damage.

The works of A. M. Korolenko, T. I. Frolovskaya, M. are devoted to the study of the influence of autohemotherapy on the course of the odontogenic inflammatory process. M. Solovyov and co-authors, V. I. Karandashov and co-authors. The method involves extracting blood from a patient’s vein and then injecting it into the muscle. Autohemotherapy increases the body's nonspecific resistance and affects hematopoiesis and the hemostatic system. According to M. M. Solovyov and co-authors, this method has a beneficial effect on the course of chronic infectious and inflammatory processes in the maxillofacial area, which is associated with changes in the tone of the parasympathetic and sympathetic-adrenal systems, with the activation of immunological processes in the lesion. During autohemotherapy, blood extracted from a vein in an amount of 5-25 ml is immediately injected into the muscle (preferably into the buttock, into its upper outer quadrant). Delay is unacceptable due to the rapid appearance of clots. Breaks between procedures are 1-2 days. Most often, up to 8-12 injections are given.

In recent years, the method of quantum hemotherapy has found application. Its essence lies in the infusion of small doses of the patient’s own blood, who has previously been exposed to ultraviolet irradiation. Its effectiveness is due to the fact that small doses of UV-irradiated blood acquire bactericidal properties and are able to inactivate toxins; they increase the nonspecific resistance of the patient’s body. A positive effect of this treatment method was noted in patients with phlegmon of the maxillofacial area, in the prevention of sepsis and the treatment of septic shock.

Eleutherococcus extract (30 drops 3 times a day half an hour before meals) or pantocrine (30-40 drops 2 times a day before meals or 1-2 ml subcutaneously or intramuscularly), Chinese Schisandra tincture ( 30-40 drops per dose 2 times a day), etc.

It is known that vitamins are necessary for all life processes. Although they are not a plastic material and do not serve as a source of energy, when they enter the body they influence the course of biochemical processes and immunogenesis in purulent-inflammatory diseases of the maxillofacial area. A lack of ascorbic acid weakens the patient’s body’s resistance and worsens the course of the inflammatory process. At the same time, the effect of a lack of this vitamin on the antibody titer and allergic reactions is clearly determined. Replenishing the lack of ascorbic acid increases phagocytic activity, enhances the formation of antibodies, prevents the formation of histamine and promotes desensitization of the body. The body's need for ascorbic acid in patients with acute odontogenic inflammatory diseases increases 2-4 times. Due to the malnutrition of patients with this pathology, they experience a decrease in the content of B vitamins and nicotinic acid. It is roughly believed that most patients with acute odontogenic diseases should receive 2 times more vitamins than healthy people.

Failure to comply with safety precautions when handling toxic substances or violation of the rules for storing pesticides leads to acute or chronic intoxication of the body. Even with timely provision of first aid, an increased concentration of toxic compounds accumulates in the tissues of internal organs, blood vessels and bones. Detoxification therapy promotes the gradual removal of toxins from the body, restoration of damaged cells, and rapid recovery of a person.

Methods of detoxification therapy

Timely cleansing of toxins from the body is often the only way to save a person’s life. Many dangerous compounds are instantly absorbed into the mucous membranes of the larynx, esophagus, and gastrointestinal tract. Vomiting that occurs during poisoning often does not help improve the condition - all the poison is already circulating through the bloodstream, entering into chemical reactions with red blood cells.

Only a set of measures using pharmacological drugs that have the ability to destroy the formed compounds and remove toxins from the body before the onset of severe irreversible consequences will help. Detoxification therapy can be carried out in two main ways:

• extracorporeal detoxification. An extensive group of therapy methods using specialized technologies to remove poison from the human body. It has found wide application in the treatment of alcohol and drug intoxication, regardless of the form of the pathology (acute or chronic). Extracorporeal detoxification is indispensable in the treatment of poisoning with chemical compounds of arsenic, mercury, chlorine, cyanides and barbiturates;
• intracorporeal detoxification. Purification is carried out using compounds capable of binding atoms of toxic toxin on their surface with their subsequent removal. Regardless of the method of entry into the body of a toxic substance or pathogenic microorganism, intracorporeal detoxification is the most effective method of first aid. The principles of action of antidotes and antidotes are based precisely on the rapid removal of poison using chemical compounds that are neutral for the human body.

Intracorporeal detoxification is more often used to treat acute forms of drug or alcohol intoxication. Extracorporeal detoxification is used to treat chronic stages of poisoning.

There are few contraindications for using all cleansing methods. These include individual intolerance to the main components of the reagents. Experts do not recommend the use of activated carbon for diseases of the gastrointestinal tract. The adsorbent irritates the mucous membrane of the stomach wall, causing its thinning and ulceration.

When is detoxification therapy used?

Detoxification is intended not only to remove toxic substances, but also to eliminate the very cause of the disease. After its use, the body gets rid of accumulated salts and toxins, which helps cure pathologies of the liver and urinary system. Detoxification therapy is especially useful for the formation of sand and small stones in the kidneys.

This method of removing toxins helps to mobilize all human resources to fight diseases by cleansing the blood, the inner lining of the stomach, and intestines from accumulated metabolic products, as well as pathogenic microorganisms.

Detoxification therapy is used for the diagnoses listed below.

• Intoxication. Decreased vital activity of the body when a toxic or poisonous substance is ingested. As a rule, the clinical picture of intoxication is similar for all types of toxins and differs only in the manifestation of some individual symptoms and the time of their onset. In response to the penetration of pathogenic viruses, bacteria and chemical compounds, the body implements protective reactions, which, as a rule, are not enough.
• Toxicosis. After harmful microorganisms enter the bloodstream, the body activates T-lymphocytes to destroy the foreign protein. In some cases, they begin to destroy their own cells and tissues, which leads to serious consequences for humans. Autoimmune diseases are often accompanied by allergic manifestations.

Specific detoxification therapy includes the use of antidotes and substances that increase the body's immune defense. For some types of poisoning, the most effective is intracorporeal detoxification, as well as detoxification using drugs that increase the production of enzymes. They are able to bind and utilize toxic compounds and increase the functional activity of all human life systems.

If there is extensive damage to the gastrointestinal tract and urinary system, it does not make sense to administer disinfectant pharmacological drugs. Damaged tissues are not able to absorb them to bind foreign protein or toxic compounds. In such cases, extracorporeal detoxification is used exclusively.

Detoxification therapy for infectious diseases normalizes and restores water-salt and electrolyte metabolism, reduces oxygen starvation of tissues, and increases their functional activity. The causative agents of infectious diseases, as well as their metabolic products of exogenous and endogenous origin, are removed from the human body. This treatment method eliminates fluid deficiency and reduces excessive blood viscosity.

Extracorporeal detoxification

This method of cleansing is most often used when it is impossible to carry out intracorporeal detoxification or when the body accumulates toxins for a long time due to alcohol, drug or chemical poisoning. Extracorporeal detoxification includes the following techniques:

• apheresis Using a special device, the blood is passed through a centrifuge, where blood cells and toxins that have not had time to form stable compounds are separated from each other. Purified blood remains in the human body, and toxic substances are sent for biochemical research;
• dialysis. The blood purification technique uses a semi-permeable membrane to separate blood cells from toxic compounds. As a result of the procedure, smaller molecules are filtered out, and high-molecular compounds remain on the surface of the membrane. Dialysis is used to remove pathogenic microorganisms, metabolic products and toxic substances;
• hemosorption. It is used in cases of extensive intoxication with psychotropic substances, neuroleptics, opioids, synthetic drugs and methyl alcohol. To purify the blood, a device is used in which the role of sorbents is given to detoxifying drugs (activated charcoal). Most often, hemosorption is used in case of poisoning with substances that can cause irreversible damage to liver cells;
• ultraviolet irradiation of blood. Used in the treatment of alcohol and drug intoxication. Detoxification therapy is based on the ability of blood to reduce its viscosity under the influence of ultraviolet radiation. As a result, pathogenic microorganisms die, the immune system is activated, and the blood is cleansed of accumulated waste and toxins. Doctors diagnose after the procedure an improvement in general well-being, a decrease in the severity of allergic reactions, and stimulation of hematopoiesis.

Intracorporeal detoxification

After a pathogenic microorganism or toxic substance enters the human body, some of the toxins bind to blood or tissue proteins, and some remain unchanged. Therefore, when carrying out intracorporeal detoxification, etiotropic and pathogenetic therapy is used.

Etiotropic therapy

Detoxification agents are used to bind, destroy and remove pathogens of viral infections., donor blood preparations with immunoglobulins:

1. Cytotect.
2. Sandoglobin.

Recently, a large selection of domestic immunoglobulins for parenteral use has appeared. Detoxification therapy for pathogens of infectious diseases is carried out with antimicrobial drugs and cephalosporin antibiotics. To destroy pathogenic viruses, the patient is recommended to take antiviral drugs for intravenous administration.

The entry of a toxic substance into the bloodstream causes not only acute poisoning - infection with harmful bacteria through lesions on the skin or food poisoning is possible. To prevent the development of acute intoxication, victims are given serums against tetanus, diphtheria, gangrene or botulism.

Etiotropic treatment as part of intracorporeal detoxification is not complete without the use of drugs that prevent the occurrence of severe complications. These include:

• antistaphylococcal plasma;
• anti-diphtheria serum.

To obtain disinfectants during research, volunteers were injected with small doses of toxic compounds or dilutions with pathogenic microorganisms. Based on the resulting antibodies, blood replacement plasmas were developed. For acute poisoning, the following types are used:

1. Antimeningococcal.
2. Antiprotean.
3. Anti-escherichiosis.

After traveling to exotic countries, people with rare types of intoxication often turn to specialists. Before therapy, such patients are prescribed etiotropic treatment using immunoglobulins to bind and remove foreign proteins or toxins.

Pathogenetic detoxification treatment

Detoxification therapy is aimed at eliminating the cause of the development of the negative process and preventing relapses. For these purposes it is used:

• reducing blood viscosity, improving its circulation through the vessels, restoring blood supply to all internal organs and the brain;
• elimination of oxygen cellular starvation, which is especially important for toxic encephalopathy of various etiologies;
• normalization of the active functioning of organs responsible for cleansing the body and removing toxic compounds.

With the help of hemodilution, the content of pathogenic microorganisms and toxic substances in the bloodstream, lymph, and lymph nodes is reduced. The volume of circulating plasma affects the receptors of the walls of blood vessels in all parts of the heart, urine filtration increases, and toxic compounds are removed from the body.

To restore active blood circulation, patients are given colloidal plasma substitutes, and in case of metabolic disorders, electrolytes. If the volume of circulating plasma is reduced, plasma substitutes are used immediately after viruses, bacteria or toxic substances enter the human body. Severe lesions accompanied by the death of brain cells require intravenous and jet administration, and for mild poisoning it is sufficient to use only intravenous injections.

Detoxification therapy is indispensable for peripheral circulatory disorders when toxins entering the body increase the permeability of small vessels and capillaries. For this purpose, agents are used that reduce the ability of toxins to form large conglomerates with blood cells, as well as drugs that have antispasmodic properties. Reoprotectors bind molecules of toxic compounds and are excreted from the body in the urine.

Intoxication with poisonous metals or poumetals, alcohol poisoning, drug overdose provoke persistent dehydration even after using intracorporeal detoxification. To maintain the water-salt balance, saline solutions are constantly administered orally or parenterally. When treating a newborn or small child, a special device is used - a nasogastric tube. Pharmacological drugs are administered directly through it in portions or continuously in small portions.

In severe intoxications, the death of parts of the brain is possible when molecular oxygen is bound by toxic substances. To ensure that the supply of cells is not interrupted, intracorporeal detoxification is carried out using the oxygenation method. Oxygen therapy is used in hospitals, in case of emergency situations at the scene.

Additional oxygen supply to the body can be carried out using the following methods:

1. Using a nasopharyngeal tube.
2. Through a nasal cannula.
3. Using an oxygen mask.

When treating acute toxic poisoning, patients are additionally injected with red blood cells, since their own are destroyed or firmly blocked by the molecules of the toxic substance. Additionally, artificial ventilation is performed, which can restore the active functioning of the brain and visceral organs. To support the urinary system, it is often enough to control the volume of circulating fluid. Due to the fact that many toxins are not able to accumulate in the structural elements of the kidneys, the number of urinations is not significantly reduced.

At home, detoxification therapy is carried out to replenish mineral salts, fluids, and protein compounds in the body. To cleanse cells and tissues of accumulated toxins, the following are used:

• fruit juices;
• berry fruit drinks;
• mineral water without gas;
• decoctions and infusions of medicinal herbs;
• green tea;

To treat acute or chronic intoxication, detoxification drugs are used: smecta, activated carbon, enterosgel, white coal. Enterodesis is recommended by doctors to restore water-salt balance. You can support the weakened body of the victim with the help of immunomodulators, vitamin complexes and a gentle diet.

Together with food, drinks (in particular alcohol) and inhaled air, substances that contain toxins can enter the human body. Their accumulation has a negative impact on health. Thanks to the activity of internal organs and systems (kidneys, liver), natural detoxification and elimination of toxic substances, as well as their metabolites (decomposition products), occurs.

When natural self-purification mechanisms fail under the influence of various factors, means are used to detoxify the body.

The cleaning method is selected taking into account the conditions that led to the deterioration of health:

Poisoning with harmful substances taken orally requires immediate gastric lavage until its contents are completely cleared. Methods of local exposure also include a cleansing enema, which helps remove feces from the intestines, preventing the absorption of harmful compounds.

For these purposes, weak solutions are used that can be prepared at home:

• potassium permanganate (“potassium permanganate”);
• baking soda;
• table salt.

The second stage is absorption. The method is effective not only for oral consumption of toxic products, but also for inhalation of vapors and smoke. The names of the most common enterosorbents, which are sold in any pharmacy and are available without a prescription:

• activated carbon;
• Enterosgel;
• Polysorb;
• Smecta;
• Polyphepan and others.

These drugs prevent further absorption of harmful components through the gastrointestinal tract, reducing the toxic effect on the body.

The next stage is the neutralization of potent compounds and their breakdown products. For alcohol, drugs, and other types of chemical intoxication, antidotes are used.

Special agents neutralize the effect of histamine, the release of which leads to the development of most known allergic reactions (skin itching, hyperemia, swelling, etc.). For example, antihistamine complexes neutralize allergens that enter from the outside or are formed as a result of autoimmune reactions. After taking desensitizing medications, a fasting diet is recommended to relieve the increased load on the liver.

Detoxification after infections is one of the ways to restore weakened immunity. Viruses, pathogenic bacteria and other pathogenic microorganisms, releasing waste products, pollute the body, worsening human well-being. Most modern antiviral drugs and antibiotics act not only on the main source of the disease, but also neutralize the effects of toxins.

Types of Detoxification Products

All drugs for detoxifying the body are divided into groups depending on the method of application and the mechanism of therapeutic effect. There are medications:

• selective action - an antidote that affects a certain type of substance (for example, the antidote for THC is sodium thiosulfate);
• wide spectrum;
• used orally (inside), injection, infusion (intravenous administration into the bloodstream);
• to activate the physiological mechanisms of self-purification (emetics, laxatives, saluretics, diuretics, others);
• for artificial detoxification (sorbents, pharmacological antagonists, plasma and blood substitutes).

The detoxification process involves the use of hardware methods of blood purification:

• hemosorption, lymphosorption - removal of toxic products and their metabolites from the blood and lymph, carried out outside the body;
• hemodialysis - extrarenal filtration with restoration of water and electrolyte balance;
• laser blood irradiation (ILBI) is a modern method of photobiological influence, improves the functioning of red blood cells, platelets, and leukocytes;
• plasmapheresis is an extracorporeal physiotherapeutic procedure that includes blood sampling, purification and return to the bloodstream;
• hemotransfusion - blood transfusion.

Despite the high effectiveness of the listed methods, they have a number of contraindications. To avoid serious complications and not cause harm to health, a preliminary medical examination should be carried out.

Injection methods

Severe forms of poisoning are treated with intravenous drips of drugs under strict medical supervision. For intravenous injections, solutions are used:

• Hemodesa;
• Neocompensana;
• Reamberina;
• Reopoliglyukina and others.

In addition to providing a detox effect, these solutions normalize blood counts, improving circulation, and have an antihypoxic effect, helping to accelerate oxygen metabolism.

Adjuvant therapy

During the period of primary treatment, as well as after its completion, experts recommend taking balanced vitamin and mineral complexes. Replenishment of nutrients allows you to:

• qualitatively improve the functioning of internal systems (stabilize hormonal levels, enzyme activity, metabolism);
• activate the body's protective functions;
• normalize well-being and psycho-emotional state.

The last aspect is especially important for comfortable withdrawal from binge drinking and recovery from drug addiction.

Most useful during the rehabilitation period:

• vitamin C - restores immunity, tones, normalizes the functioning of the cardiovascular system;
• B vitamins - have a positive effect on the functioning of the central nervous system and endocrine system;
• potassium, sodium, calcium - necessary for the full functioning of internal organs, they are destroyed in large quantities during alcoholism and drug addiction;
• magnesium - good for the nervous system.

To eliminate problems with the emotional background, sedatives are prescribed that have a calming, relaxing effect. Their intake is especially important to prevent the development of withdrawal symptoms (withdrawal) after stopping the use of alcoholic beverages or drugs.

The main share of toxins is deposited in the liver. To protect its cells from destructive influences, you should take a course of hepatoprotectors. They prevent the development of cirrhosis, promote tissue regeneration and restoration of organ functions.

At home, you should adhere to a dietary diet. The following should be excluded from the diet:

• fried, pickled, smoked dishes;
• alcoholic drinks;
• strong tea, coffee.

It is advisable to limit the consumption of salt and sugar. Be sure to enrich your diet with fresh vegetables, fruits, and herbs. To remove toxins as quickly as possible, it is important to maintain a drinking regime. An adult needs to drink at least 2 - 2.5 liters of clean water daily.

Detoxification of the body is a cleansing procedure that allows you to restore the normal functioning of all organs and systems. For mild forms of poisoning, it can be done at home. In case of acute, severe intoxication, immediate seeking of qualified medical help is required.

Detoxification therapy is the removal of toxic substances from the body. Poisonous substances can be not only those that enter the body from the external environment, but also those formed inside it. Most often, patients are admitted to the hospital with alcohol poisoning, drug overdose, or poisoning by toxic vapors. The method of removing toxins in such patients is approximately the same. However, if a toxic agent is released inside any organ or system, then the mechanism for carrying out therapeutic measures will change somewhat.

Detoxification therapy is divided into two large groups: extracorporeal detoxification and intracorporeal detoxification. They are divided primarily according to the direction of action. Intracorporeal neutralization of the body is aimed at removing the toxin naturally (through the excretory system). It is carried out by introducing antidotes of toxic substances, as well as colloidal and crystalline solutions to replenish the blood volume and normalize kidney function.

Extracorporeal detoxification is carried out not inside the body, but “outside”, by artificially removing toxins using mechanized technology.

Intracorporeal detoxification therapy can be carried out with the following drugs:

1. Saline solutions are used when the body loses a large amount of fluid. As you know, during intoxication, the vomiting mechanism is most often activated to remove toxins, so patients lose a lot of fluid.

Detoxification drugs that replenish lost fluid volume are available in bottles of 200 and 400 ml. This division was created for ease of administration based on the volume of fluid missing in the body.

The most commonly used drugs are:

"Disol" - sodium chloride - 600 mg, sodium citrate - 200 mg.

Ringer's solution - contains sodium, potassium, calcium and chlorine ions.

2. In case of intoxication with large loss of fluid, detoxification therapy is indicated, the preparations of which contain a glucose solution. Glucose is the main energy source in the body, so it is simply necessary for the full functioning of all systems.

3. Colloidal solutions can be divided into synthetic and natural (natural). In practice, synthetic solutions are almost always used, these include:

Dextrans

- analogues of hydroxyethyl starch

— “Gellatinol”

4. Osmodiuretics are also actively used to remove toxic substances from the body. Representative: Monnitol. These drugs prevent the development of kidney failure and accelerate the process of eliminating toxic substances.

5. To maintain the acid-base balance, it is necessary to use a 9% solution of sodium bicarbonate or potassium chloride.

Detoxification therapy through artificial purification of blood and other biological substrates can be carried out using the following methods:

1. Hemosorption is the passage of blood through a special sorbing filter, as a result of which all toxic substances of large and medium size are removed.
2. Plasmapheresis is the separation of blood into red blood cells and plasma. Then the formed elements are returned back to the bloodstream, and the toxic plasma is replaced with identical donor plasma.
3. Plasmasorption is a method similar to plasmapheresis, only it is not replaced with donor plasma, but its own is purified.
4. Lymphosorption - passing lymph through a sorbing filter.
5. Hemodialysis - “artificial kidney”.
6. Laser and ultrasound irradiation of blood.

Detoxification therapy with extracorporeal methods is carried out only in cases of threat to the patient’s life, when other methods do not help.

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Detoxification therapy is a set of measures aimed at removing toxins from the body. Indications for the use of such therapy are clinical signs of intoxication: repeated vomiting, diarrhea, abdominal cramps, pallor, thirst, tachycardia, possibly increased body temperature, etc.

Ways to remove toxins

There are many ways to get rid of toxins, but the most commonly used are:

1. Drink plenty of fluids. Drinking detoxification therapy is an easy and convenient way to remove toxins. The patient drinks alkaline mineral waters, compotes, tea. The drug "Regidron" is prescribed, which must be diluted in one liter of water and consumed throughout the day.

2. Infusion therapy. It is used when it is necessary to restore the body’s loss of water, protein and electrolytes when it is impossible to receive them through the gastrointestinal tract. For detoxification purposes, crystalloid drugs (saline, glucose) are used, which carry out delution and increase diuresis. The use of blood substitutes with adsorbing action (the drug “Hemodez”) increases the efficiency of removing toxins from the body. In severe cases, blood plasma or albumin is used.

3 .
rsified diuresis. It is controlled hemodilution. During the day, up to 5 liters of crystalloid solutions are administered with mandatory hematocrit monitoring. Detoxification therapy also uses drugs that have a diuretic effect. The dosage is selected individually and with caution, since excessive use can cause water and electrolyte imbalance in the body.

4. Extracorporeal methods of detoxification. Methods that purify blood outside the body. These methods include hemodialysis, plasmapheresis, hemosorption, ultraviolet irradiation of blood.

Detoxification therapy using hemodialysis

Hemodialysis is performed using an artificial kidney. The method is used to remove nitrogen metabolism products, toxic substances, excess fluid and electrolytes from the blood. This type of therapy is more often used for poisoning with dialysable substances, fungi, or acute renal failure.

Hemosorption

This method is used for severe poisoning with psychotropic drugs, barbiturates, tranquilizers, and hepatotoxic substances. Sorbents are synthetic detoxification preparations and activated carbon of plant origin. Hemosorption is carried out using a special apparatus and under conditions of general heparinization of the blood.

Detoxification therapy using plasmapheresis

This method is best suited for patients with hematological, autoimmune, liver and kidney diseases. In case of liver disease, plasmapheresis partially removes bilirubin, bile acids, lipids from the blood, and helps reduce cholemic intoxication (yellowing of the skin, itching).

UV blood

With the help of blood irradiation, it is possible to achieve remission of many diseases: alcohol or drug intoxication, purulent skin diseases, diseases of the nervous and bronchopulmonary systems, inflammatory processes in the joints, etc.

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The essence of the technique

In the case of all kinds of poisoning, when providing first emergency aid and stabilizing a person’s condition, an increased level of accumulation of toxic substances is noted in the tissues and internal systems of the body, in bones, joint and vascular tissue. They are the ones that should be removed in order to return the patient to good health.

Detoxification agents used during these procedures work to gradually cleanse internal systems, organs and resuscitate damaged cells.

Alcohol detoxification includes a large, carefully developed set of specialized measures that are aimed at quickly and safely relieving a severe hangover. This condition usually develops after excessive and prolonged consumption of alcoholic beverages.

Also, this technique becomes the basis when starting treatment of a patient for alcoholism. In addition, a timely cleansing procedure allows you to avoid the severe consequences of withdrawal symptoms and hangovers.

Detoxification for alcohol addiction

Alcoholism is one of the most acute and widespread problems in our country. After prolonged harmful effects on the body of toxic metabolites of ethyl alcohol, a person develops abstinence syndrome. This condition is accompanied by a number of unpleasant and painful manifestations. Such as:

• insomnia;
• nervousness;
• headaches;
• pressure surges;
• hypersweating;
• tremor of the whole body.

And a number of other signs indicating intoxication of the body. Detoxification drugs used during cleansing work to significantly alleviate the condition by helping to neutralize remaining toxins and remove them from the body. The presence of a pathology such as alcohol addiction provokes the patient to develop a number of dangerous and sometimes fatal diseases.

The narcologist must take this into account when developing a detoxification method. This therapy is selected taking into account the initial state of health, drinking experience, gender, age of the patient. Existing chronic diseases must also be taken into account. Doctors divide alcohol disorders into several main types:

1. Alcoholic psychoses.
2. Chronic alcoholism.
3. Acute poisoning with alcohol products.

In cases of acute alcohol poisoning, patients especially need relief from withdrawal symptoms and detoxification. Indeed, in this case, the risk of significant destruction of organic functions is too great. But if alcohol poisoning is superficial and insignificant, the body can cope with the negative consequences on its own. In such a situation, there is no need for hospitalization and detoxification measures.

Methodology used

As a rule, methods of detoxification for alcohol poisoning are based on the intravenous administration of a number of necessary drugs. Such as:

• in case of alcohol poisoning without pronounced symptoms of mental disorders, vitamin complexes Piracetam or Unitol are included in infusion therapy;
• if alcohol intoxication occurs against the background of various complications from the central nervous system, mental disorders, narcologists use antipsychotic medications (for example, Relanium or Tazepam).

Additionally, various means are used to stabilize night disorders, diuretics. All methods used for detoxification in alcoholism consist of a combination of several main methods, in particular:

1. Washing and cleansing the stomach.
2. Infusion therapy (droppers).
3. Therapeutic measures (symptomatic).

Gastric lavage (probing)

This measure is the best way to stop further absorption of poisonous and toxic residues of the metabolic products of ethyl alcohol into the internal systems. This procedure also works to reduce the load on the liver, stabilize it and, accordingly, significantly improve the functioning of the entire body.

The simplest and most accessible method of gastric cleansing is the simultaneous intake of 2-3 tablespoons (large) of crushed activated carbon. The patient is then given a lot to drink and vomiting is induced. To do this, press on the root of the tongue.

When performing gastric intubation, narcologists often use subcutaneous administration of Apomorphine (0.2–0.5 ml of 1% solution).

After vomiting, the patient should rinse the throat and mouth thoroughly. Then, at the end of the lavage procedure, sodium bicarbonate (50 ml of a 4% solution) is injected into the gastric cavity using a probe. At the same time, the patient is given an aqueous solution of ammonia to drink (10–15 drops of ammonia are dissolved in 150 ml of water).

Carrying out infusion therapy

Droppers serve several purposes when cleansing the body of ethanol residues. Infusion therapy is aimed at:

1. Blood purification.
2. Stabilization of water balance.
3. Regulation of electrolyte balance.
4. Restoration of acid-base level.

This event is especially important and necessary if a person has acute alcohol poisoning (this situation has a high chance of developing into an alcoholic coma). The drugs used are selected by narcologists in accordance with the physiological characteristics of the patient and his current condition.

Intravenous infusion of a healing solution based on insulin, glucose, nicotinic and ascorbic acid helps to significantly alleviate the condition of the victim and reduce alcohol intoxication. Most often, droppers include:

• glucose;
• saline;
• ascorbic and nicotinic acid;
• Metadoxil (in combination with isotonic solution).

Metadoxil's work is aimed at accelerating the liver's production of a certain enzyme (alcohol dehydrogenase). This liver compound works to neutralize and remove alcohol residues from the body. Ultimately, this leads to increased oxidation and neutralization of ethanol metabolites.

All these measures taken together help to significantly reduce the severity of the syndrome and significantly reduce its duration. To restore the water balance to normal, use intravenous infusion of sodium chloride and glucose solution (isotonic). Healthy electrolyte levels are stabilized by potassium chloride solution.

In the case of acute alcohol intoxication, infusion therapy often requires various additional measures (for example, ventilation, oxygen supply). Therefore, such treatment must be carried out in a hospital setting.

Symptomatic therapy

These measures are necessary when the narcologist is faced with the task of simultaneously providing the patient with detoxification measures the normal functioning of organic systems important for life. Such as:

• respiratory function;
• work of the nervous system;
• complete blood supply.

In case of observed disturbance of breathing processes, the patient is treated with analeptic drugs. In this situation, drugs such as Sulphocamphocaine or Caffeine are administered (subcutaneously). If these medications are ineffective, artificial ventilation of the lungs is performed..

If problems are observed in the functioning of the heart, cardiotropic medications (a group of cardiac glycosides) are added to treatment. Mildronate, Mtrofantine or Corglicon are often used. Caffeine is also used in case of a sharp drop in blood pressure. And for high blood pressure, Trental, Papaverine, No-shpu, magnesia or Eufillin are administered.

Diuretics such as Lasix or Mannitol can also be used. Many narcologists recommend including combined medications in infusion therapy (in the treatment of somatic disorders) that work to improve hemodetic processes.

A rather important and necessary component for detoxification treatment is taking medications that work to restore and protect the liver. The most effective among these drugs are Heptral and Essentiale. These patients are also indicated for treatment using nootropics (for example, Piracetam) and ATP (sodium adenosine triphosphate).

It is very important for detoxification procedures to include medications based on vitamins C and B-group into therapy. These compounds work to restore redox reactions and carbohydrate metabolism. They also have a beneficial effect on the functioning of the respiratory and nervous systems and significantly improve the supply of oxygen to tissues.

Solutions and preparations used

When carrying out detoxification measures, narcologists use medications of various purposes. Most often used:

1. Antispasmodics, such as No-shpa, Papaverine.
2. Sugar solutions. Type Sodium bicarbonate or Glucose.
3. Psychotropic drugs (Tiapridal, Flormidal or Relanium).
4. Solutions of Panagin, Ringer, Calcium chloride or isotonic suspension.
5. Hepatoprotective medications (Mildronat, Heptral, Metadoxil, Piracetam or Essentiale).
6. Fortified medications (Calcium pangamate, Pyrodixin, ascorbic and nicotinic acid, Thiamine).
7. Drugs with analeptic and psychostimulating effects. Such as Natrium-caffeine benzoate or Cordiamine.
8. Blood purification products (Rondex, Reomacrodex, Reopoliglyukin or Reogluman). Neohemodez and hemodez solutions are also used.

All these drugs can be administered to the patient using droppers. Moreover, several drugs of different directions can be used for detoxification at once.

It is very important to carry out the cleansing procedure in a clinical setting, where a narcologist, after examining the patient, will develop an individual treatment regimen.

But in the conditions of a stationary sobering-up center, they achieved rapid sobering up of an alcoholic with an injection solution consisting of:

• corazole;
• phenamine;
• saline solution;
• nicotinic acid;
• vitamin B6 (5% solution).

In this case, after only 10-15 minutes, doctors achieved improvement in the functioning of the nervous system functions of the body. And after an hour and a half, the intoxicated person was completely sobered up.

Let's summarize

Infusion therapy (using a dropper) can be carried out at home, but with the obligatory call of a narcologist. You should know and remember that any intravenous infusion of any drugs must take place under the close supervision and guidance of a specialist.

It is necessary to understand that all these measures aimed at cleansing the body of ethanol metabolites only work to alleviate and relieve withdrawal symptoms. But this technique is not able to save a person from the problem of drunkenness. Treatment of this disease requires a completely different approach using the complex efforts of a psychotherapist and a narcologist.

vsezavisimosti.ru

Choice of treatment method

To choose the right method of therapy to remove harmful substances from the body, you need to determine the type of alcohol disorder. Doctors distinguish several main types of this condition:

• chronic alcoholism;
• alcoholic psychosis;
• acute form of alcohol intoxication.

With the development of mild or moderate intoxication, special therapy is not required. If an acute stage is diagnosed, detoxification therapy is certainly prescribed. Otherwise, there is a risk of disruption of the functioning of important organs.

With the help of such treatment, it is possible to eliminate the main signs of a hangover and bring the patient out of the binge state. To do this, the patient is given intravenous medications. Most often, droppers with vitamin complexes are used.

If a person has mental disorders, a toxicologist will prescribe tranquilizers. For sleep problems, sedatives are indicated. With alcoholism, a lot of waste and toxins accumulate in the body. Therefore, a toxicologist may prescribe diuretic medications.

Types of detoxification therapy

How to detoxify the body? To do this, use the following methods:

• intubation or gastric lavage;
• infusion therapy;
• symptomatic therapy.

Probing of the stomach

This procedure stops alcohol from entering the bloodstream from the digestive organs. For this purpose, the toxicologist prescribes a sorbent - for example, activated carbon. Then the specialist performs gastric lavage using a tube.

Detoxification at home can be done using plain water. You need to drink it in one gulp and then induce vomiting. The oral cavity also needs to be cleaned.
Then a 4% sodium bicarbonate solution is injected into the stomach. If necessary, you can use a solution of ammonia.
Another quick and effective way of detoxification is the intramuscular injection of a 5% solution of vitamin B6 and a special medicinal mixture. It contains phenamine, nicotinic acid, corazol. Droppers with these substances are also used, which help to quickly cleanse your body of waste and toxins.
Literally 50-100 g of the composition in a quarter of an hour can restore the functioning of the autonomic nervous system. Due to this, emotional disinhibition disappears. Within an hour the person recovers, becoming completely sober.

Infusion therapy

This detoxification technique is aimed at restoring the acid-base balance. With its help, it is possible to improve the water-electrolyte composition and blood characteristics. To carry out this procedure, the toxicologist selects drugs individually. It helps to bring a person out of an acute state of intoxication.
To solve this problem, you need to reduce the level of alcohol in the blood. To cleanse the body, a person is given IVs using the following medications:

• 1% solution of nicotinic acid;
• 40% glucose solution;
• 5% vitamin C solution.

In some cases, detoxification therapy is performed by intramuscular or intravenous use of metadoxil. In the second case, the use of a dropper is indicated. It is important to consider that it is performed using an isotonic solution.
To bring the patient out of the state of acute intoxication due to alcoholism, urgent therapy is carried out. It consists of performing injections of analeptic mixtures, which are accompanied by inhalation of a composition based on oxygen and carbon dioxide.
To protect your body from dehydration, you need to use a glucose solution with a concentration of 5%. To normalize blood characteristics, drugs such as Rondex, Reogluman, etc. are used.

Symptomatic therapy

This type of treatment is aimed at maintaining the functioning of important organs. If the respiratory center is affected, the use of analeptics is indicated. In this case, the toxicologist prescribes drugs such as a 10% solution of sulfocamphocaine and a 25% solution of caffeine.

If such detoxification therapy does not produce the desired results, the toxicologist prescribes tracheal intubation and artificial ventilation. With the development of acute or chronic heart failure, the toxicologist prescribes cardiotropic drugs - for example, cardiac glycosides.
Chronic intoxication can cause the development of cardiomyopathy. This provokes heart rhythm disturbances, which must be taken into account when choosing therapy. Urinary dysfunction is eliminated by catheterization of the bladder.
In addition, complete detoxification therapy is impossible without the help of a psychotherapist. The final result depends on quality treatment.

Consequences

It is important to consider that single droppers help to quickly remove alcohol breakdown products and cleanse your body of toxins and toxic substances. For alcohol detoxification to be as successful as possible, it must take quite a long time.
The removal of decomposition products can take several days. This is why IVs need to be placed in a hospital setting. In this case, they not only use drugs that remove alcohol, but also monitor the state of the blood, calculate diuresis and monitor laboratory parameters.
Droppers and medications to remove harmful substances provide the following results:

Rehydration – helps maintain normal micro- and marcocirculation. This helps replenish fluid reserves in the body.
It is known that alcoholism causes chronic dehydration of the body. As the blood becomes thicker, the risk of heart attacks and strokes increases, and the functioning of the kidneys and liver is impaired.
Droppers and special medications help replenish fluid reserves. Due to this, complete detoxification of the liver and other organs is carried out.

1. Restoration of acid-base and water-electrolyte balance. As a result of prolonged alcohol consumption, sodium and potassium salts are washed out of the body, which negatively affects the functioning of the heart. The drugs prescribed by the toxicologist help restore the extracellular and intracellular composition of fluids and quickly eliminate the symptoms of underlying disorders.
2. Intensive detoxification – ensures rapid removal of toxins and waste from the body. It is alcohol intoxication that leads to withdrawal syndrome. If you wait to eliminate toxins on your own, the symptoms of a hangover will bother you for a long time. Therefore, a toxicologist may prescribe an intravenous infusion of a solution of sterofundin, hemodez N or reamberin. This helps to cleanse the body much faster and get the patient out of the binge.

Proper detoxification of the body ensures rapid removal of ethanol breakdown products and eliminates the main symptoms of a hangover. The main thing is that tablets and other medications are selected by a qualified toxicologist.

alkogolu.net

DISINTOXICATION THERAPY ( French prefix des-destruction, removal + intoxication; Greek, therapeia treatment) - therapeutic measures aimed at stopping or reducing the intensity of the effect of toxic substances on the body. In the broad sense of the word D. t. includes treatment. help both with exogenous intoxications of all types, constituting one of the aspects of the wedge, toxicology (see), and to treat. measures to accelerate the elimination of toxic substances of endogenous origin from the body. The main mechanisms of detoxification in case of exogenous poisoning are neutralization, fixation and release of poisons (see Detoxification).

Already in ancient times, in order to reduce the concentration of toxic substances in the blood, bloodletting, various emetics and laxatives, and gastric lavage were widely used. The possibilities of D. t. have significantly expanded with the introduction into the wedge, the practice of specific antidotes (antidotes), methods of exchange blood transfusion, forced diuresis, peritoneal dialysis, hemodialysis using an artificial kidney apparatus.

The scope and methods of D. t. for exogenous poisoning are largely determined by the specific action of the toxic substance on the body (see Poisoning).

Causal therapy for endogenous intoxication is the treatment of the underlying disease and its complications that lead to the formation and accumulation of toxic substances. The mechanisms available in the body to overcome intoxication (see) - antitoxic function of the liver and reticulohistiocytic system, elimination of toxic substances by the kidneys, gastrointestinal organs. tract, etc. - often, if they are preserved, they turn out to be sufficient, due to which neither the wedge, manifestations of intoxication, nor the need for the use of D. t. drugs arise. The latter always serves only as an addition to the treatment of the main pathol, process and cannot replace this type of treatment. D. t. is prescribed if there is a wedge, signs of intoxication, if the nature or prevalence of patol, the process allows us to foresee the imminent occurrence of signs of intoxication, if the functional state of the internal organs, especially the liver and kidneys, requires preventive measures to reduce the concentration of toxic substances in the blood and accelerating their elimination, as well as in cases where causal therapy is untenable or impossible (hepatargia syndromes, end-stage renal failure).

In case of endogenous intoxications, D. t. is carried out in the following pathogenetic directions: 1) hemodilution (see) in order to reduce the concentration of toxic substances circulating in the blood; for this purpose, drink plenty of fluids, parenterally administer isotonic salts and glucose; the total volume and rate of fluid administration is set depending on the wedge and the patient’s condition; 2) improving blood supply to tissues and organs to accelerate the leaching of toxic substances; This purpose is served by intravenous drip administration of rheologically active drugs of low molecular weight dextrans (see), polyvinylpyrrolidone (see), which also have the ability to bind toxins and promote their excretion in the urine, since these drugs, for example, hemodez, improve renal blood flow. Their daily dose is limited to hl. arr. due to the possibility of developing arterial hypertension and therefore the administration of these drugs alone is usually not enough to ensure the required degree of hemodilution and forced diuresis; 3) acceleration of the excretion of toxic substances in the urine, undertaken, as a rule, after hemodilution and the introduction of rheologically active drugs and carried out by the formation of diuresis using significant doses of fast-acting diuretics, for example, furosemide (see), provided that renal function is preserved and in the absence of arterial hypotension.

Methods of extrarenal blood purification occupy a special place in D. t. Being very effective, they are used for special indications, ch. arr. for severe intoxications, as they require special equipment and qualified personnel. Such methods include exchange blood transfusion (see), plasmapheresis (see), selective removal of individual protein fractions from the blood plasma using an extracorporeal separator, peritoneal dialysis (see), hron, hemodialysis (see). A method of “artificial liver” is being developed for D. t. in some forms of liver failure.

In addition to the general principles outlined above, D. in some cases also includes some private measures prescribed for special indications. Thus, for hyperammonemia, 1% glutamic acid solution is administered intravenously (in severe cases, up to 1000 ml per day); In case of toxic effects on the myocardium of digitalis preparations, unithiol is used. In both cases, the principle of action of complexones is used (see).

Carrying out D. t. requires systematic clinical and laboratory control in order to avoid its negative consequences for the patient’s condition, which may be caused by a violation of the composition of electrolytes in the body and water metabolism. Dangerous complications of improperly performed D. t. can be both hypervolemia and hyperhydration, leading to circulatory decompensation (with the development of anasarca, pulmonary edema, cerebral edema), and hypovolemia and dehydration with arterial hypotension, a drop in diuresis down to anuria, and the appearance of phlebothrombosis ( due to hemoconcentration), threatening embolism in the arteries of the pulmonary circulation. More rare side effects of D. t. are a decrease in myocardial tolerance to cardiac glycosides, a decrease in the effectiveness of antibiotics and other treatments. drugs, deposition of polyvinylpyrrolidone in the cells of the glomerular apparatus of the kidney, migration of stones in the bile or urinary tract, allergic reactions to administered drugs.

See also Antidotes of chemical agents, Autointoxication, Detoxification, Antidotes.

Bibliography: Weisbein S. G. Emergency conditions in the clinic of internal diseases, M., 1966, bibliogr.; Glozman O. S. and Kasatkina A. P. Detoxification therapy for acute poisoning and autointoxication, Tashkent, 1970, bibliogr.; Treatment of acute poisoning, ed. M. L. Tarakhovsky, Kyiv, 1973, bibliogr.; Guide to clinical resuscitation, ed. T. M. Dar-binyan, p. 141, M., 1974; Guide to the toxicology of chemical agents, ed. G. N. Golikova, M., 1972, bibliogr.; Emergency assistance for acute poisoning, Handbook, comp. E. A. Luzhnikov and A. P. Golikov, M., 1976.

V. B. Yakovlev.

bme.org

Pain relief and antispasmodic therapy of the pancreas

To relieve pain, parenteral administration of non-narcotic analgesics is recommended:
. ketoprofen 0.1-0.2 g in 100-500 ml of 0.9% sodium chloride solution intravenously or 100 mg 1-2 times a day intramuscularly;
. butorphanol 2 mg every 3-4 hours intravenously or intramuscularly;
. tramadol 0.05-0.1 g every 6 hours intravenously or intramuscularly;
. metamizole sodium 5 ml intravenously or intramuscularly 2-3 times a day.

The effectiveness of non-narcotic analgesics is increased by the use of histamine H1 receptor blockers (diphenhydramine, chloropyramine, irometazine), which, in addition to the synergistic effect with analgesics, also have their own pathogenetic effect, manifested in blocking the effects of histamine and histamine-like substances. In addition, antihistamines have antiemetic and sedative effects.

Pain relief is especially effective when combining non-narcotic analgesics with injections of antispasmodics:
. 1.0 ml of 0.1% atropine solution and 1.0 ml of 0.1% indomethacin solution subcutaneously or intravenously every 6 hours;
. drotaverine 2.0 ml intramuscularly every 4 hours;
. platiphylline 1-2 ml of 0.2% solution 2 times a day

The most pronounced effect is exerted by chlorosil, which is approximately 10 times superior in antispasmodic effects to all M-cholipolytics, including atropine. In the complex treatment of abdominal pain syndrome, ganglion blockers are also used in standard doses (ganglefen, azamethonium bromide). They have analgesic, antispastic and antisecretory effects. When using ganglion blockers, it is necessary to remember their pronounced hypotensive effect.

M-anticholinergics have a large number of side effects, due to which they are contraindicated for tachyarrhythmias, glaucoma, prostate adenoma and other diseases. This is why the selective M1 anticholinergic pirenzepine has recently been preferred. This drug primarily affects the functional state of the gastrointestinal tract, possessing a complex of necessary medicinal properties. In addition to the blocking effect on gastric and pancreatic secretion, pyrexpin regulates gastrointestinal motility, reduces the tone of the sphincter of Oddi and improves microcirculation in the pancreas. Restrictions on the use of pirenzepine are duodenostasis.

We should not forget that regional artificial hypothermia of the pancreas area reduces the activity of metabolic processes in it, suspends the activation of pancreatic enzymes and the kinin system, reduces swelling of the organ and, therefore, has an analgesic effect. Cooling of the pancreas zone to 30-35 °C is carried out using Hypotherm devices or an ice pack.

Immediate action drugs, especially for ischemic pancreatitis, include nitroglycerin and amyl nitrite, which can reduce or stop spasm of the sphincter of Oddi and improve microcirculation in the pancreas. Nitroglycerin is prescribed intravenously as a slow infusion (5-10 mg of nitroglycerin per 400 ml of any saline solution) under the control of systemic blood pressure and heart rate.

It is advisable to administer procaine (100-250 ml of 0.25% solution intravenously at a frequency of 20-40 drops per minute) under the control of hemodynamic parameters. In addition to the anesthetic effect, procaine inhibits the activity of phospholipase A2, reduces intraductal pressure and the tone of the sphincter of Oddi. In case of low blood pressure or tachycardia, you can use an oral mixture of glucose-procaine mixture, which has a good effect in relieving pain (5% glucose solution + 0.5% procaine solution, two dessert spoons every 2-3 hours).

A severe pain attack that is not relieved by the above drugs requires the use of narcotic drugs. It should be remembered that morphine is contraindicated in the treatment of pancreatitis, since it causes spasm of the sphincter of Oddi. For severe pain, trimeperidine (1-2 ml of a 2% solution subcutaneously) is often used. If necessary, trimeperidine can be administered every 4 hours in combination with antispasmodics intravenously.

If there is no effect from the use of non-narcotic drugs and trimeperidine, neuroleptanalgesia (2.5-5.0 mg of droperidol with 0.05-0.1 mg of fentanyl) can be prescribed for 3-4 hours. In case of severe abdominal pain syndrome, it is advisable to immediately prescribe narcotic analgesics in combination with non-steroidal anti-inflammatory drugs, which allow one-time and daily doses of narcotic drugs to be somewhat reduced.

Infusion and detoxification therapy

The main objectives of infusion therapy are detoxification, correction of volemia and hemorheology, electrolyte balance and acid-base status. Hemodilution improves microcirculation in the pancreas and prevents the development of pancreatic necrosis. At the first stage, the bulk of infusion media should be colloidal blood substitutes. The optimal combination of dextran and gelatinol in a 1:1 ratio should be considered. Starch preparations (gelofusin, infucol, volecam) have a good volemic effect, improve the rheological properties of blood, microcirculation in tissues and kidney function, and do not affect hemostasis.

Based on this, they should be given preference over dextrans, which can disrupt the functions of platelets and kidneys. After achieving hemodilution and restoring the normal hematocrit level (0.43-0.45), it is possible to use glucose-coated polyionic solutions and balanced salt solutions in a 2:1 ratio. First, 7 ml/kg of blood substitutes are administered intravenously over 20-30 minutes, and then switched to drip administration at a dose of 10-15 ml/kg. The total fluid requirement is 3.0 liters per day or more.

Infusion of blood substitutes is carried out under the control of heart rate and central venous pressure (60-120 mm Hg), diuresis (40-60 ml/h), blood pressure (systolic pressure should be at least 90 mm Hg), studies of lactic acid levels, bicarbonate content and blood pH. Transfusion of red blood cell-containing media and fresh frozen plasma is indicated only when the hematocrit decreases below 20%.

After compensation for the volume of circulating blood, the required amount of injected fluid is determined based on the amount of urine excreted, pathological loss and perspiration (800-1000 ml), minus 500 ml due to the formation of endogenous fluid. To compensate for alkaline reserves, a solution of sodium bicarbonate (or lactate) is administered, however, when drawing up an infusion program, the need for simultaneous correction of hypochloremia and alkalosis should be taken into account.

Detoxification infusion therapy may include isotonic solutions of sodium chloride and glucose, but the use of polyionic solutions that simulate the composition of extracellular fluid (Ringer-lactate Viaflo, Chlosol, Acesol, etc.) is more effective. Colloidal blood substitutes (hemodez, neohemodez, gelatinol) increase plasma volume and improve microcirculation, bind some types of endogenous toxic substances, promote the movement of fluid between sectors of the extracellular fluid space and increase the flow of albumin from the interstitium into the bloodstream, and stimulate diuresis.

A 10% albumin solution (100-200 ml/day) has a good detoxification effect. Polyvisolin, which includes a combination of polyvinyl alcohol with glucose and glutamine, is intended for the immobilization and biotransformation of endogenous toxic substances by stabilizing the detoxification function of the liver.

The detoxifying dose of such solutions is 5-10 ml/kg for hemodez and neohemodez, 10-20 ml/kg for polyvisolin and at least 20-25 ml/day for gelatinol.

When carrying out infusion therapy, diuretics are not indicated for most patients, since oliguria resolves on its own with the disappearance of hypervolemia and normalization of renal function, however, there is evidence that some diuretics (triampur compositum and acetozolamide) reduce pancreatic edema and abdominal pain syndrome.

Forced diuresis is carried out in the absence of pronounced dystrophic and necrobiotic changes in the filtration department of the nephron and the tubular apparatus of the kidneys, as well as while maintaining an adequate response of the circulatory system to the infusion load, hypervolemia and hemodilution. Water retention in the body during one session of forced diuresis should not exceed 2% of the patient’s body weight.

Maev I.V., Kucheryavyi Yu.A.

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The goal of detoxification is to remove toxins and prevent or reduce the entry of toxic products into the blood. This is achieved through early surgery - excision or opening of the source of inflammation with removal of pus and necrotic tissue. Necrectomy is achieved mechanically (surgically), as well as using physical (laser, ultrasound) or chemical (proteolytic enzymes) means, followed by the use of drainage. In a number of diseases (purulent pleurisy, purulent arthritis), exudate and pus containing toxins are removed using punctures, through the use of drainage systems with active aspiration of purulent discharge and necrolysis products (formed when necrotic tissue melts). Simultaneous sanitation of a purulent focus does not always give a positive result, since the inflammatory process and tissue necrosis can continue. In such cases, repeated sanitation of the lesion is carried out using mechanical removal of pus, fibrin, exudate, excision of necrotic tissue, and their removal using ultrasound cavitation or laser.

To remove stagnant contents of the stomach and intestines, enteral drainage is used (insertion of a probe through the mouth into the stomach or small intestine), cleansing, siphon enemas, enterosorption - the introduction of a sorbent (activated carbon) into the intestine in order to deposit toxins located in the intestine on its surface.

To combat developed toxemia, two ways are used - methods that have a detoxification effect in the human body (intracorporeal detoxification), or blood, plasma, lymph are removed from the body and passed through special sorbents or filters to remove toxins - extracorporeal detoxification.

Intracorporeal detoxification is performed with preserved filtration function of the kidneys and is aimed at stimulating the excretory functions of the body: forced diuresis, restoration of gastrointestinal motility, as well as reducing the concentration of toxins by diluting the blood (hemodilution), binding toxic substances due to the introduction of blood-substituting fluids with a detoxifying effect. The simplest method of intracorporeal detoxification is infusion therapy, aimed at diluting the blood and binding toxins with their subsequent removal by the kidneys. Solutions of electrolytes (polyionic solutions), dextrose, and dextran are used as infusion agents [cf. they say weight 30,000-40,000], blood-substituting fluids with detoxification effects (see Chapter 7).

An important detoxification method for severe purulent diseases is forced diuresis. It is simple and based on the use of the natural process of removing toxic substances from the body by the kidneys, taking into account their concentration and excretory function.

Forced diuresis involves preliminary hemodilution (blood dilution) and increased excretory capacity of the kidneys. Stimulation of the concentration-excretory function of the kidneys is preceded by the introduction of transfusion media that provide moderate hemodilution. For this purpose, solutions of crystalloids and low-molecular dextrans are used, and in case of hypovolemia, protein blood-substituting fluids are pre-administered. Preliminary water loading involves the introduction of 1000 ml of Ringer-Locke solution, 500 ml of 3% sodium bicarbonate solution and 400 ml of dextran [cf. they say weight 30,000-40,000]. After this, diuretics are administered - mannitol at a dose of 1-1.5 g/kg or furosemide (40-80 mg) - and the infusion of a 5% dextrose solution (total - 1000-1500 ml) and protein preparations (blood plasma, albumin solution, protein hydrolysates) - 1000-1500 ml. In total, the patient receives 4000-5000 ml of fluid and excretes 3000-4000 ml of urine. An hourly recording of the amount of fluid administered and urine excreted through a permanent catheter is carried out (300-400 ml/h).

The correctness of the forced diuresis is controlled by monitoring the electrolyte and protein balance of the body, the acid-base state (ABS), the level of residual nitrogen, and central venous pressure. Transfusion media include solutions of potassium chloride (40-60 ml of 10% solution), sodium chloride (50 ml of 10% solution), calcium chloride (30 ml of 10% solution) per 1000-1500 ml of 5% dextrose solution.

If necessary, forced diuresis can be repeated daily for several days.

Plasmapheresis is based on the separation of plasma by centrifuging the blood and removing it along with the toxins in it. The formed elements of blood are returned to the patient’s bloodstream. At the same time, up to 1000 ml of plasma is removed, replacing it with transfusion of donor albumin and plasma. Plasmapheresis allows you to remove toxic substances such as necrotic bodies, polypeptides, proteolytic enzymes, and immune complexes.

Hemosorption based on the use of carbon sorbents and a roller pump. In one session, up to 10 liters of blood are subjected to sorption - the patient’s circulating blood passes through the sorbent columns twice, which allows you to quickly and effectively reduce the concentration of toxic substances in it such as creatinine, bilirubin, urea. The concentration of medium molecules is reduced less effectively. The negative aspects of the method are the absorption of proteins and electrolytes by the sorbent, partial destruction of leukocytes, erythrocytes, and platelets.

A lasting detoxification effect can be achieved lymphosorption. Lymph for sorption is obtained from the drained thoracic lymphatic duct. As a result of lymphosorption, the concentration of urea, creatinine, bilirubin, CEC, necrotic bodies, and proteolytic enzymes significantly decreases.

At the same time, during lymphosorption, a natural loss of lymphocytes and proteins occurs, as a result of which the body’s immune reactions are inhibited.

Hemofiltration and hemodialysis are based on the principle of removing toxins from the patient’s blood through semi-permeable membranes that allow toxins to pass through, while keeping the patient’s blood - plasma, formed elements - intact. These methods do not require replenishment of blood plasma. Hemofiltration removes a wider range of toxins than hemodialysis. Hemodialysis (“artificial kidney”) is used for kidney failure to remove toxins from the blood. In chronic renal failure, the method is used for repeated repeated (over several years) removal of metabolic products.

In the process of treating patients, methods of intra- and extracorporeal detoxification can be combined and used differentiatedly, taking into account the nature of toxic substances accumulating in the blood.