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

Emergency Care and Intensive Care of Acute Poisoning
Features of intensive care of acute poisoning in the elderly

The diminished adaptive capacity of the body in elderly and senile age contributes to specific features in the clinical course of acute poisonings, which ultimately impacts disease outcomes and the specifics of intensive care management.

As a rule, The Development of major pathological syndromes in acute poisonings occurs more slowly. The incidence of complications increases, intercurrent infections supervene, and chronic comorbidities exacerbate. Patient recovery is slower, and pathological syndromes and symptoms are more likely to become chronic (such as chemical Burns of the Esophagus and Stomach, toxic hepatopathy and nephropathy).

Acute stress responses to chemical trauma occur quite rarely and at later stages.

Exotoxic Shock in elderly patients develops slowly, persistently, and in a wave-like manner.

With Aging, the progression of Homeostasis disturbances is slower, accompanied by a prolonged recovery of impaired Functions caused by exotoxic shock. Special attention should be paid to the reduced tolerance to various toxic substances in elderly individuals, as evidenced by a sharp decrease in the critical and irreversible Blood concentration levels of toxins.

Intensive care for acute poisonings in elderly patients requires an individualized approach, particularly regarding infusion therapy. Excessive fluid administration is extremely dangerous for them due to the risk of hyperhydration, pulmonary edema, cavity and peripheral effusions, and other signs of circulatory failure. This is caused by reduced myocardial reserve, diminished renal filtration capacity, and other factors. An increase in CVP to 105-110 mm H₂O in elderly individuals is a sign of hyperhydration. Therefore, it is essential to closely monitor key parameters of central and peripheral hemodynamics, acid-base balance, osmotic status, plasma electrolyte levels, hourly diuresis, and the patient's body weight.

During the first 2–3 hours post-poisoning, drug infusions in elderly patients are administered at a rate of 5–6 ml/min. Subsequently, as diuresis increases and CVP drops, the rate may be increased to 15–20 ml/min, ensuring that CVP remains at 80–90 mm H₂O.

When selecting Diuretics, preference is given to furosemide, administered at a dose of 50–80 mg hourly for 3–4 consecutive times. This regimen helps maintain a stable hourly diuresis (300–500 ml) and satisfactory daily diuresis (4–5 L). Electrolyte solutions should be supplemented with 20 ml of Panangin or Asparkam to help prevent Heart Failure.

Artificial detoxification Methods are employed as Procedures of choice.

Symptomatic pharmacological therapy in elderly individuals requires extreme caution and consideration of individual tolerance.