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

Emergency Care and Intensive Care of Acute Poisoning
Specific Features of Intensive Care in Acute Poisoning

The primary cause of cellular dysfunction and death in poisoning is direct toxic damage to cellular and membrane structures. This leads to The Development of so-called membrane diseases, the Pathogenesis of which involves three main causes:

1) damage to the membrane by its own phospholipase, activated by Calcium Ions during severe Hypoxia;

2) Lipid Peroxidation activated by ferrous iron ions, oxygen, chlorinated Hydrocarbons, and free Hemoglobin;

3) «mechanical» osmotic damage, for instance, in poisoning with Ethylene glycol and oxalic acid.

A significant role in membrane damage is played by immune processes. This is driven by METABOLISM/18.html">The Influence of Antibodies produced in response to the penetration of Organic compounds that form close bonds with Plasma Proteins (cardiac Glycosides, barbiturates, etc.).

Direct damage to Cell membranes and cellular metabolism leads to profound alterations in specific tissue Functions: regulatory (when The Nervous system is damaged), contractile (when the myocardium is damaged), detoxifying (when the Liver is damaged), and excretory (when the Kidneys are damaged). The combined disruption of these functions hinders the full manifestation of compensatory responses in the body's Organs and systems.

From a clinical standpoint, irreversibility in Acute Poisoning is manifested by severe impairments in the Functions of the Brain, Cardiovascular system, Respiratory system, and other organs and systems, culminating in multiple organ failure. The pathogenetic links of specific syndromes in acute poisoning are illustrated in Fig. 2.

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Fig. 2. Pathogenetic links of specific syndromes as factors driving irreversibility in acute poisoning

Timely detoxification and correction of pathological disorders in cases of Exotoxic Shock, hypoxia, and endotoxemia are the primary approaches for preventing irreversible processes in acute poisoning. The following algorithm for emergency therapeutic measures aimed at preventing and treating this condition is recommended.

1. Restoration and maintenance of adequate external respiration (intubation, tracheostomy, mechanical ventilation, Oxygen therapy).

2. Measures aimed at restoring central and regional hemodynamics, microcirculation, and cellular metabolism. This primarily involves restoring circulating Blood volume, Cardiac Output, normal central venous and arterial pressure, and correcting acid-base balance (ABB) and hemorheological disorders.

3. Preservation of Central Nervous System viability under conditions of hypoxia and toxic edema (craniocerebral hypothermia, Hyperbaric Oxygenation, lumbar puncture, dehydration, Muscle relaxants, tranquilizers).

4. Restoration and maintenance of liver and Kidney function (infusion therapy, hemosorption, hemodiafiltration, etc.).

5. Administration of antidotes (antidotal therapy).

6. The efficacy of complex Treatment is significantly enhanced During the first hours of the toxicogenic stage.