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

General Characteristics of Acute Poisoning
The Concept of Poison and Poisoning. Classification of Acute Poisoning

Poisoning (intoxication) is a pathological condition, usually critical, that develops As a result of the interaction between The Human Body and toxic substances of various origins entering from the environment. Virtually any chemical compound capable of disrupting vital Functions and posing a life-threatening hazard can act as a poison. The concepts of exo- and endotoxicosis exist, meaning that poisoning can occur either through the penetration of toxic substances from the external environment or as a result of a pathological process occurring within the body (such as an infection, medical condition, oncological process, or surgical intervention).

Since poisoning is caused by a poison, it is necessary to define this term. There are many Structure/97.html">Definitions of METABOLISM/2.html">THE CONCEPT OF "poison." First and foremost, a poison is a foreign chemical compound that disrupts normal biochemical processes in the body, leading to physiological functional disorders of varying severity, ranging from mild symptoms of intoxication to a fatal outcome.

From a pathogenetic perspective, Acute Poisoning should be viewed as a chemical trauma that develops as a result of a toxic dose of a foreign chemical substance entering the body.

There is no single Classification of poisonings due to their etiological diversity, the vast number of toxic substances, the variety of routes by which they enter the body, and the conditions and modes of interaction between poisons and the Organism. The most common classification of poisonings is based on the name of the substance that caused them (e.g., poisoning by chlorophos, arsenic, dichloroethane, etc.), the group to which the toxic agent belongs (e.g., barbiturates, acids, alkalis, etc.), or an entire Class uniting various chemicals by their common application (e.g., pesticides, medications) or origin (plant, animal, or synthetic poisons).

The classification of acute poisonings is based on three main principles: etiopathogenetic, clinical, and nosological.

According to etiopathogenetic factors, acute poisonings are categorized as follows.

I. Accidental.

1. Occupational.

2. Domestic:

a) inadvertent;

б) medication overdose;

в) alcohol or drug intoxication.

3. Medical errors (iatrogenic poisonings).

II. Intentional poisonings.

1. Criminal:

а) with intent to kill;

б) as a means of incapacitation.

2. Suicidal.

By the route of entry of the poison into the body:

1. Inhalation

2. Oral

3. Percutaneous

4. Injection

By clinical course:

1. Acute poisonings develop upon the single-moment entry of a toxic dose of poison into the body.

2. Chronic poisoning is caused by the prolonged entry of poisons into the body in small (subtoxic) doses.

According to the severity of the condition, the following are distinguished:

1. Mild poisoning.

2. Moderate poisoning.

3. Severe poisoning.

4. Fatal poisoning.

The etiological factor of poisoning is a chemical substance that accumulates in the body at a toxic concentration capable of causing disruption of Homeostasis and the natural detoxification system, which continuously cleanses the body of toxic substances of exogenous or endogenous origin.

The most common classifications of toxic substances are as follows. Classification of poisons by their field of application:

1. Industrial poisons used in manufacturing: organic Solvents (dichloroethane), fuels (methane, propane, butane), Dyes (aniline), refrigerants (freon), chemical Reagents (methyl alcohol), plasticizers, etc.

2. Pesticides used in agriculture for pest control of crops: organochlorine pesticides — hexachlorane, polychlorpinene, etc.; organophosphorus insecticides (OPPs) — dichlorvos, karbofos, chlorophos, phosphamide, trichlorometaphos-3, methylmercaptophos, etc.; organomercury compounds — granosan, etc.

3. Medications that have their own pharmacological classification.

4. Household chemicals used domestically: food additives (acetic acid), sanitation, personal care, and cosmetic products, products for garment, furniture, and car care, etc.

5. Biological PLANT AND ANIMAL poisons found in various plants and mushrooms (aconite, Water hemlock, etc.), animals, and insects (snakes, bees, scorpions, etc.), which cause poisoning upon entering the body.

6. Chemical warfare agents (CWAs), The Use of which as toxic weapons and a means of chemical warfare for mass destruction remains part of the military plans of various countries to this day (sarin, mustard gas, phosgene, etc.).

According to their degree of toxicity, chemical substances are divided into the following:

1. Extremely toxic (CWAs, thiophos, strychnine, hydrocyanic acid preparations).

2. Highly toxic (methyl alcohol, CCl₄, dichloroethane).

3. Moderately toxic (benzene, phenol, herbicides).

4. Low-toxicity (certain herbicides and insecticides).

Depending on selective toxicity, the following are distinguished:

1. Cardiac poisons, leading to Cardiac Arrhythmias and myocarditis — cardiac Glycosides, tricyclic antidepressants, hellebore, quinine, barium and potassium salts.

2. Neurotoxic poisons, leading to psychoses, seizures, and comatose states — narcotics, hypnotics, OPPs, carbon monoxide, alcohol, and its surrogates.

3. Hepatic poisons, leading to The Development of hepatopathy and hepatargia — chlorinated Hydrocarbons, poisonous mushrooms, phenols, and aldehydes.

4. Blood poisons, leading to hemolysis and methemoglobinemia — aniline, nitrites.

5. Pulmonary poisons, leading to pulmonary edema and fibrosis — nitrogen oxides, phosgene.

6. Nephrotoxic poisons causing nephropathy and ACUTE RENAL FAILURE include Ethylene glycol, heavy metal compounds, and oxalic acid.

7. Gastrointestinal poisons causing gastroenteritis and gastrointestinal bleeding include acids, alkalis, heavy metals, arsenic, etc.