Intensive Care of Acute Poisoning - A. V. Hovenko 2010

Introduction

List of Abbreviations

ADH - Alcohol dehydrogenase

ALT - Alanine aminotransferase

ALDH - aldehyde dehydrogenase

AST - aspartate aminotransferase

CWA - chemical warfare agents

ICU - intensive care unit

WEE - Water-electrolyte balance

HBO - Hyperbaric Oxygenation

ARF - Acute Respiratory Failure

ARF - ACUTE RENAL FAILURE

DIC syndrome — disseminated intravascular coagulation syndrome

CBC - complete Blood count

UA - urinalysis

UA - urinalysis

IC - intensive care

ABC - acid-base balance

LSD - lysergic acid diethylamide

RPM - regimental medical post

UDMH - unsymmetrical dimethylhydrazine

BV - blood volume

LPO - Lipid Peroxidation

CPR - cardiopulmonary resuscitation

MV - mechanical ventilation

GIT - gastrointestinal tract

ESR — ERYTHROCYTE SEDIMENTATION RATE

CVP - central venous pressure

CNS - Central Nervous system

OPI - organophosphorus insecticides

OPS - organophosphorus compounds

ChE - cholinesterase

OCS - organochlorine compounds

CCl₄ - carbon tetrachloride

p_aO₂ - arterial blood oxygen partial pressure

p_aCO₂ - arterial blood carbon dioxide partial pressure

Class="center">Introduction

Acute Poisoning occurs when chemical substances of various origins enter The Human Body in quantities sufficient to disrupt vital Functions and pose a life-threatening hazard. The smaller the amount (dose) of a chemical substance required to cause poisoning, the higher its toxicity, i.e., its poisonous potency. Acknowledging this universal property of chemical substances, the famous ancient physician Paracelsus famously stated that “all things are poison and nothing is without poison.”

Poisoning remains a persistent challenge in clinical medicine, as toxic chemicals are ever-present in the human environment. This issue has gained particular urgency with the advancement of chemistry, especially concerning chemical agents widely utilized in industry, agriculture, everyday life, medicine, and other fields. Improper use or storage of most of these substances leads to acute and chronic poisonings. The number of patients admitted for poisoning exceeds those hospitalized for acute myocardial infarction, while the mortality rate is twice as high as that resulting from motor vehicle accidents.

Acute poisoning (AP) is a chemical illness (injury) that develops As a result of the single-dose exposure of the human body to a foreign chemical substance (xenobiotic) at a toxic level. The widespread use of various chemicals in medical practice, everyday life, and the national economy, combined with a complex social environment, high-paced lifestyles, and the rise of alcoholism, substance abuse, drug addiction, as well as neurological and psychiatric disorders, all contribute to the incidence of AP. Industrial accidents and disasters frequently involve the synergistic effects of multiple chemicals. For instance, the combustion of polymers generates nearly 130 chemical compounds. Their cumulative toxic effect is unpredictable, particularly when combined with thermal and mechanical trauma.

Currently, so-called “technical fluids” are widely employed in industry, agriculture, and by the armed forces as Solvents, antifreezes, fuels, and raw Materials for the Synthesis of Other products. Along with technological progress and expanded equipment utilization, There is a growing number of service members and workers who come into contact with various technical fluids. Many of these fluids are highly toxic and, under certain conditions, can cause both acute and chronic poisoning. In the event of disasters, there may be a need to provide primary and specialized toxicological care to the families of service members due to chemical hazards and AP. Poisonings can be occupational in nature, resulting from safety violations. Domestic poisonings occur when technical fluids are ingested accidentally or intentionally, frequently for the purpose of intoxication. The most frequent and severe acute poisonings involve substances such as Ethylene glycol and its derivatives, chlorinated Hydrocarbons (dichloroethane, carbon tetrachloride, trichloroethylene), methyl alcohol, and other alcohols.

Due to the significant intensification of chemical use in the national economy, medical professionals increasingly encounter acute domestic poisonings resulting from the accidental or intentional ingestion of highly toxic chemicals.

Household chemical products, the variety of which is constantly growing, alcohol and its surrogates, potent medications, poisonous plants, and many other substances remain sources of poisoning in both urban and rural areas.

Industrial accidents, fires, and domestic mishaps often involve inhalation poisonings from domestic gas and carbon monoxide, aerosol pesticides, and other toxic compounds released into the atmosphere or confined spaces.

Mushroom poisonings are quite common, particularly during the summer and autumn seasons. Other hazards include venomous snake bites, Insect stings, etc.

In Ukraine, the overall incidence of acute chemical poisonings is not decreasing; rather, it shows a moderate upward trend, reflecting global patterns. The clinical profile of acute poisonings is shifting, with psychotropic medications (hypnotics, tricyclic antidepressants, tranquilizers, etc.) and cardiotoxic agents (clonidine, calcium antagonists, beta-blockers) predominating. High rates of alcohol intoxication, narcotic comas, mushroom poisonings, hematologic toxins (carbon monoxide, methemoglobin Inducers), and pesticides persist. In certain regions (such as Kyiv), the proportion of elderly and geriatric patients, as well as children among poisoning victims, is increasing. The threat of mass Chemical Poisoning incidents remains, particularly in industrial regions of Ukraine.

AP is characterized by a sudden onset, polymorphic clinical manifestations, rapid progression, and the frequent development of critical conditions. According to the literature, critical conditions of various types develop in 60% of acute poisoning cases. These include toxic coma, acute respiratory failure, Exotoxic Shock, acute cardiovascular failure, and acute hepatic and renal failure. In deep coma and shock, the toxicokinetics of the poison are disrupted, increasing its Circulation time in the blood and decreasing its half-life. Therefore, the management of patients with moderate to severe AP must be prompt and adequate, as this ensures life-saving outcomes and the restoration of health for the poisoned individuals in the majority of cases. In other instances, Treatment is multifaceted, costly, and requires subsequent neurological and long-term rehabilitation.

Acute poisonings represent a complex field of clinical toxicology in terms of Diagnosis and treatment, carrying high clinical relevance and significant military-applied importance. Consequently, every military physician is obligated to know how to diagnose poisonings, provide prompt and timely emergency care, prescribe feasible and accessible treatments within the capabilities of their medical facility, and correctly determine The Need for further evacuation of such patients to specialized medical centers. Unjustified delays, inadequate medical interventions, and improper or untimely evacuation can cause irreversible harm, resulting in death or life-threatening complications. It is strictly prohibited to leave a patient—even with mild forms of poisoning or suspected intoxication—without necessary pre-hospital monitoring and treatment.