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

Methods of Detoxification Therapy
General Characteristics of Detoxification Methods

A key feature of intensive care for severe acute Chemical Poisoning is the simultaneous administration of two primary types of Treatment: artificial detoxification and supportive therapy aimed at maintaining general Homeostasis and the function of Organs and Organ Systems primarily targeted by the substance due to its selective toxicity.

To ensure maximum clinical efficacy, comprehensive treatment for Acute Poisoning is tailored to the severity of the chemical injury, The Nature of the toxic agent, the stage of the toxic process driven by the interaction between the poison and the body, and the patient's adaptive physiological reserves.

The Methods of symptomatic intensive care for critical conditions in acute poisoning do not fundamentally differ in their indications or techniques. They aim to support or replace impaired respiratory Functions (tracheal intubation, mechanical ventilation) and cardiovascular functions (infusion therapy, pharmacotherapy for Shock and arrhythmias, and mechanical circulatory support).

Artificial detoxification methods reduce the body's toxic burden (a specific effect) by supplementing natural elimination pathways, while also temporarily replacing renal and hepatic functions when necessary.

Detoxification is The process of halting or mitigating the effects of a toxic substance and clearing it from the body. Based on their MECHANISM OF ACTION, detoxification methods are classified into techniques that enhance the body's natural clearance processes, artificial detoxification methods, and antidotes.

1. Methods for Enhancing the body's natural detoxification processes

A. Stimulation of elimination

Gastrointestinal Decontamination:

- emesis induction;

- gastric lavage;

- bowel irrigation (whole-bowel irrigation, enema);

- laxatives (saline, oil-based, herbal);

- pharmacological stimulation of intestinal peristalsis (intramuscular administration of 10-15 ml of 4% potassium chloride solution, 40% glucose solution, and 2 ml (10 IU) of pituitrin hydrochloride);

- selective bowel decontamination (Antibiotics).

Forced diuresis:

- Water-electrolyte loading (oral, parenteral);

- osmotic diuresis (mannitol, sorbitol).

Therapeutic Pulmonary Hyperventilation

B. Stimulation of biotransformation

Regulation of hepatocyte Enzymatic Function:

- enzymatic induction (zoxazolamine/zisorin, phenobarbital);

- enzymatic inhibition (levomycetin, cimetidine).

Therapeutic hyper- or hypothermia (pyrogenal)

Hyperbaric Oxygenation

C. Stimulation of Blood immune system activity

Physiohemotherapy (ultraviolet, magnetic, laser)

Pharmacological correction (tactivin, myelopid)

2. Methods of artificial Physical and Chemical detoxification

Apheretic:

- plasma substitute preparations;

- hemapheresis (blood replacement);

- plasmapheresis, cryapheresis;

- lymphapheresis;

- perfusion of The Lymphatic system.

Dialysis and filtration methods.

Extracorporeal methods:

- hemo- (plasma-, Lymph-) dialysis;

- ultrafiltration;

- hemofiltration;

- hemodiafiltration.

Intracorporeal methods:

- peritoneal dialysis;

- intestinal dialysis.

Sorption:

Extracorporeal methods:

- hemo- (plasma-, -lymph-) sorption;

- applicative sorption;

- biosorption (Spleen), allogeneic Liver Cells.

Intracorporeal methods:

- enterosorption.

Physiohemotherapy (in a special mode when combined with other Methods of artificial detoxification):

- ultraviolet blood irradiation;

- laser blood irradiation;

- magnetic blood Processing;

- electrochemical blood oxidation (sodium hypochlorite);

- ozone therapy.

Surgical and endoscopic:

for the mechanical evacuation of toxins from Tissues and cavities.

3. Antidotal (pharmacological) detoxification

Chemical antidotes (toxicotropic):

- contact action;

- parenteral action.

Biochemical antidotes (toxicokinetic)

Pharmacological antagonists (symptomatic)

Antitoxic immunotherapy.