Modern ways of detoxifying the body. Body detoxification: artificial and natural methods

In most developed countries, there has been an increase in domestic and suicidal poisoning. There is a trend towards an increase in cases of acute poisoning with medicines, household chemicals.

The outcome of acute poisoning depends on early diagnosis, quality in the timeliness of treatment, preferably even before the development of severe symptoms of intoxication.

The main materials on the diagnosis and treatment of acute poisoning are presented in accordance with the recommendations of Professor E. A. Luzhnikov.

At the first meeting with the patient at the scene necessary

establish the cause of poisoning,
type of toxic substance, its amount and route of entry into the body,
poisoning time,
the concentration of a toxic substance in a solution or a dose of drugs.

It should be remembered that acute poisoning is possible with the introduction of toxic substances into the body through

mouth (oral poisoning),
respiratory tract (inhalation poisoning),
unprotected skin (percutaneous poisoning),
after injections of a toxic dose of drugs (injection poisoning) or
the introduction of toxic substances into various cavities of the body (rectum, vagina, external auditory canal, etc.).

For the diagnosis of acute poisoning it is necessary to determine the type of chemical drug that caused the disease by the clinical manifestations of its “selective toxicity”, followed by identification by methods of laboratory chemical-toxicological analysis. If the patient is in a coma, differential diagnosis of the most common exogenous poisonings is carried out taking into account the main clinical symptoms (Table 23).

Table 23. Differential diagnosis of coma in the most common poisonings

Designations: sign "+" - the sign is characteristic; the sign "O" - the sign is absent; in the absence of a designation, the sign is insignificant.

All victims with clinical signs of acute poisoning must be urgently hospitalized in a specialized center for the treatment of poisoning or in the hospital of the ambulance station.

General principles of emergency care for acute poisoning

When providing emergency assistance, the following actions are necessary:

1. Accelerated removal of toxic substances from the body (methods of active detoxification).
2. Neutralization of the poison with the help of antidotes (antidote therapy).
3. Symptomatic therapy aimed at maintaining and protecting the vital functions of the body, selectively affected by this toxic substance.

Methods of active detoxification of the body

1. Gastric lavage through a tube- an emergency measure for poisoning with toxic substances taken orally. For washing, use 12-15 liters of water at room temperature (18-20 ° C1 in portions of 250-500 ml.

In severe forms of poisoning in patients who are in an unconscious state (poisoning with hypnotics, organophosphorus insecticides, etc.), the stomach is washed 2-3 times on the first day, because due to a sharp slowdown in resorption in a state of deep coma in the digestive apparatus a significant amount of unabsorbed substance can be deposited. At the end of the gastric lavage, 100-130 ml of a 30% solution of sodium sulfate or vaseline oil is administered as a laxative.

For the early release of the intestines from the poison, high siphon enemas are also used.

Patients in a coma, especially in the absence of cough and laryngeal reflexes, in order to prevent aspiration of vomit into the respiratory tract, gastric lavage is performed after preliminary intubation of the trachea with a tube with an inflatable cuff.

For the adsorption of toxic substances in the digestive apparatus, activated charcoal with water is used in the form of slurry, 1-2 tablespoons inside before and after gastric lavage, or 5-6 tablets of carbolen.

In case of inhalation poisoning, the victim should first of all be taken out of the affected atmosphere, laid down, freed from clothing that constrains him, and oxygen is inhaled. Treatment is carried out depending on the type of substance that caused the poisoning. Personnel working in the area of the affected atmosphere must have protective equipment (insulating gas mask). In case of contact with toxic substances on the skin, it is necessary to wash it with running water.

In cases of introduction of toxic substances into the cavities (vagina, bladder, rectum), they are washed.

For snake bites, subcutaneous or intravenous administration of toxic doses of drugs, cold is applied topically for 6-8 hours. Injection of 0.3 ml of a 0.1% solution of adrenaline hydrochloride into the injection site is indicated, as well as circular novocaine blockade of the limb above the site of entry of toxins. The imposition of a tourniquet on a limb is contraindicated.

2. Forced diuresis method- the use of osmotic diuretics (urea, mannitol) or saluretics (lasix, furosemide), which contribute to a sharp increase in diuresis, is the main method of conservative treatment of poisoning, in which the excretion of toxic substances is carried out mainly by the kidneys. The method includes three successive stages: water load, intravenous diuretic administration and electrolyte replacement infusion.

The hypoglycemia developing in severe poisoning is preliminarily compensated by intravenous administration of plasma-substituting solutions (1-1.5 l of polyglucin, hemodez and 5% glucose solution). At the same time, it is recommended to determine the concentration of a toxic substance in the blood and urine, electrolytes, hematocrit, in order to measure hourly diuresis, introduce a permanent urinary catheter.

A 30% urea solution or a 15% mannitol solution is injected intravenously in a stream at the rate of 1 g / kg of the patient's body weight for 10-15 minutes. At the end of the administration of the osmotic diuretic, a water load is continued with an electrolyte solution containing 4.5 g of potassium chloride, 6 g of sodium chloride and 10 g of glucose per 1 liter of solution.

The rate of intravenous administration of solutions should correspond to the rate of diuresis - 800-1200 ml / h. If necessary, the cycle is repeated after 4-5 hours until the osmotic balance of the body is restored, up to the complete removal of the toxic substance from the bloodstream.

Furosemide (Lasix) is administered intravenously from 0.08 to 0.2 g.

During forced diuresis and after its completion, it is necessary to control the content of electrolytes (potassium, sodium, calcium) in the blood and hematocrit, followed by a rapid recovery of established violations of water and electrolyte balance.

In the treatment of acute poisoning with barbiturates, salicylates and other chemical preparations, the solutions of which are acidic (pH below 7), as well as in case of poisoning with hemolytic poisons, alkalization of the blood is shown along with the water load. To do this, from 500 to 1500 ml of 4% sodium bicarbonate solution are intravenously administered intravenously per day with simultaneous control of the acid-base state to maintain a constant alkaline urine reaction (pI more than 8). Forced diuresis allows you to speed up the elimination of toxic substances from the body by 5-10 times.

In acute cardiovascular insufficiency (persistent collapse), chronic circulatory failure NB-III degree, impaired renal function (oliguria, increased blood creatinine content of more than 5 mg%), forced diuresis is contraindicated. It should be remembered that in patients older than 50 years, the effectiveness of forced diuresis is reduced.

3. Detoxification hemosorption by perfusion of the patient's blood through a special column (detoxifier) with activated carbon or another type of sorbent - a new and very promising effective method for removing a number of toxic substances from the body.

4. Hemodialysis using the apparatus "artificial kidney"- an effective method for the treatment of poisoning by "analyzed" toxic substances that can penetrate through a semi-permeable membrane? bran dialyzer. Hemodialysis is used in the early "toxicogenic" period of intoxication, when the poison is determined in the blood.

Hemodialysis in terms of the rate of purification of blood from poisons (clearance) is 5-6 times higher than the method of forced diuresis.

In acute cardiovascular failure (collapse), uncompensated toxic shock, hemodialysis is contraindicated.

5. Peritoneal dialysis It is used to accelerate the elimination of toxic substances that have the ability to be deposited in adipose tissues or bind firmly to plasma proteins.

This method can be used without reducing the clearance efficiency even in cases of acute cardiovascular insufficiency.

With a pronounced adhesive process in the abdominal cavity and in the second half of pregnancy, peritoneal dialysis is contraindicated.

6. Blood replacement surgery blood recipient (OZK) is indicated for acute poisoning with certain chemicals and causing toxic blood damage - the formation of methemoglubin, a prolonged decrease in cholinesterase activity, massive hemolysis, etc. The effectiveness of OZK in terms of clearance of toxic substances is significantly inferior to all the above methods of active detoxification and .

OZK is contraindicated in acute cardiovascular insufficiency.

Emergency conditions in the clinic of internal diseases. Gritsyuk A.I., 1985

Gastric lavage through a tube- This is an emergency measure for poisoning with toxic substances taken orally. For washing use 12-15 liters of water at room temperature (18-20°C) in portions of 250-500 ml.

In severe forms of poisoning in patients who are in an unconscious state (poisoning with sleeping pills, organophosphorus insecticides, etc.), the stomach is washed 2-3 times on the first day, since due to a sharp slowdown in resorption in a state of deep coma, it can be deposited in the digestive apparatus a significant amount of unabsorbed substance. At the end of the gastric lavage, 100-130 ml of a 30% solution of sodium sulfate or vaseline oil is administered as a laxative.

For the early release of the intestines from the poison, high siphon enemas are also used.

For the adsorption of toxic substances in the digestive apparatus, activated charcoal with water is used in the form of a slurry, 1-2 tablespoons inside before and after gastric lavage or 5-6 tablets of carbolen.

In case of inhalation poisoning, first of all, the victim should be taken out of the affected atmosphere, laid down, freed from clothing that constrains him, and oxygen is inhaled. Treatment is carried out depending on the type of substance that caused the poisoning. Personnel working in the area of the affected atmosphere must have protective equipment (insulating gas mask). In case of contact with toxic substances on the skin, it is necessary to wash it with running water.

In cases of introduction of toxic substances into the cavities (vagina, bladder, rectum), they are washed.

forced diuresis method- this is the use of osmotic diuretics (urea, mannitol) or saluretics (lasix, furosemide), which contribute to a sharp increase in diuresis, is the main method of conservative treatment of poisoning, in which the excretion of toxic substances is carried out mainly by the kidneys. The method includes three successive stages: water load, intravenous diuretic administration and electrolyte replacement infusion.

The hypoglycemia developing in severe poisoning is preliminarily compensated for by intravenous administration of plasma-substituting solutions (1-1.5 l of polyglucin, hemodez and 5% glucose solution). At the same time, it is recommended to determine the concentration of a toxic substance in the blood and urine, electrolytes, hematocrit, in order to measure hourly diuresis, introduce a permanent urinary catheter.

A 30% urea solution or a 15% mannitol solution is injected intravenously in a stream at the rate of 1 g / kg of the patient's body weight for 10-15 minutes. At the end of the introduction of the osmotic diuretic, the water load is continued with an electrolyte solution containing 4.5 g of potassium chloride, 6 g of sodium chloride and 10 g of glucose per 1 liter of solution.

Furosemide (Lasix) is administered intravenously from 0.08 to 0.2 g.

In the treatment of acute poisoning with barbiturates, salicylates and other chemical preparations, the solutions of which are acidic (pH below 7), as well as in case of poisoning with hemolytic poisons, alkalization of the blood is shown along with the water load. To do this, from 500 to 1500 ml of 4% sodium bicarbonate solution are intravenously administered intravenously per day with simultaneous control of the acid-base state to maintain a constant alkaline urine reaction (pH over 8). Forced diuresis allows you to speed up the elimination of toxic substances from the body by 5-10 times.

In acute cardiovascular insufficiency (persistent collapse), chronic circulatory failure IIB-III degree, impaired renal function (oliguria, increased blood creatinine content of more than 5 mg%), forced diuresis is contraindicated. It should be remembered that in patients older than 50 years, the effectiveness of forced diuresis is reduced.

Detoxification hemosorption by perfusion of the patient's blood through a special column (detoxifier) with activated carbon or another type of sorbent - a new and very promising effective method for removing a number of toxic substances from the body.

Hemodialysis using the "artificial kidney" apparatus- an effective method for the treatment of poisoning by "dialyzable" toxic substances that can penetrate the semi-permeable membrane of the dialyzer. Hemodialysis is used in the early "toxicogenic" period of intoxication, when the poison is determined in the blood.

Hemodialysis in terms of the rate of purification of blood from poisons (clearance) is 5-6 times higher than the method of forced diuresis.

In acute cardiovascular failure (collapse), uncompensated toxic shock, hemodialysis is contraindicated.

Peritoneal dialysis It is used to accelerate the elimination of toxic substances that have the ability to be deposited in adipose tissues or bind firmly to plasma proteins.

This method can be used without reducing the clearance efficiency even in cases of acute cardiovascular insufficiency.

With a pronounced adhesive process in the abdominal cavity and in the second half of pregnancy, peritoneal dialysis is contraindicated.

Blood replacement surgery recipient blood donor (OZK) is indicated for acute poisoning with certain chemicals that cause toxic blood damage - the formation of methemoglobin, a prolonged decrease in cholinesterase activity, massive hemolysis, etc. The effectiveness of OZK in terms of clearance of toxic substances is significantly inferior to all the above methods of active detoxification.

OZK is contraindicated in acute cardiovascular insufficiency.

Prof. A.I. Gritsyuk

"Methods of active detoxification of the body in case of poisoning"– section

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It is generally accepted that detoxification of the body concerns only drug addicts and alcoholics. Let's clarify. In the process of life, the human body accumulates various toxins that come with food. They are just as harmful as those that enter the body along with drugs and alcohol. Therefore, cleansing the body is recommended to be carried out periodically.

Neutralization and localization of the action of toxic substances is achieved by physical, chemical and biological methods. It is used not only in the rehabilitation of patients with alcohol and drug addiction, but also in the usual cleansing of the body from the same toxic substances.

Observations of scientists convincingly prove that not all poisons and chemicals are excreted from the body naturally. Their residues accumulate in human adipose tissues. Moreover, they are found even after a long time in both alcoholics and drug addicts who have undergone successful treatment and rehabilitation. Therefore, detoxification of the body is an essential condition for the process of healing patients with drug and alcohol addiction.

Even after stopping the use of drugs, the human body may feel an echo of its former disease. Clots of toxins “lingering” in the body cause actions similar to those that were during the period of taking drugs. They penetrate deeply into tissues and are periodically activated even after treatment. Any of the previously used drugs can remind you of yourself - heroin, cocaine, peyote, mescaline, ecstasy.

In addition, food preservatives, drug residues, pesticides and chemical waste can accumulate in human tissues. As long as they are within the "limits" of the body, they are able to activate repeated sensations. They will constantly remind of their presence until they are completely removed from the body. And you can do this with the help of detoxification techniques and drugs.

They are mandatory in the first place for people suffering from drug addiction. This procedure cannot be skipped, because drugs, affecting the work of a person’s internal organs, change his behavioral mood, attitude towards himself from the environment, “rewrite” family life and lifestyle in society according to a new scenario. They impede the development of the personality, its improvement, hinder the development of the mind and worsen the "indicators" of the level of mental health of a person.
Procedures for detoxification of the body, as a rule, are carried out within a month, more precisely, 2-3 weeks. The remains of toxins gradually leave the body and, accordingly, their influence is reduced to the limit. According to eyewitnesses, a person returns after the procedures new - in high spirits, with a desire to live.

General principles

Specialists pay paramount attention to the treatment of acute poisoning. In such cases, treatment is required in two directions - symptomatic therapy and artificial detoxification. In some cases, special attention is paid to antidote therapy, which, through the use of a certain set of drugs, reduces the toxicity of poisons present in the body.

Methods of intensive symptomatic therapy are aimed at maintaining and replacing dysfunctions of the cardiovascular and respiratory systems.

Artificial detoxification activates the body's natural cleansing processes, supplementing them, and also takes over some of the functions of the liver and kidneys. It includes methods of extra- and intracorporeal detoxification, blood transfusion, hemodedulation, plasmapheresis, quantum hemotherapy and some others. In modern clinical practice, they are known as hemodialysis, hemosorption, plasmasorption, etc.

The set of "tools" is large, therefore, for their effective use, doctors need to choose the right combination of these methods using a set of techniques and taking into account the individual characteristics of the patient. At the same time, the severity of the disease, the type of toxin, the features of its interaction and the reaction of the body, dictated by the adaptive capabilities of the drug addict, are not left without attention.

Once upon a time, our ancestors actively cleansed the body with emetic, diuretic compounds, with the help of various folk baths and steam rooms, enemas and fasts. Supporters of many of them can be found today.
But!

The same bath is not always available to everyone, and not all methods are good: sometimes they can do harm, i.e. the effect may be reversed.

For example, not all enemas are useful, because not every composition in them is useful to the body. Vomiting techniques have been abandoned today for various reasons, explaining this by “discomfort” and causes of direct physical harm to the body.

Today, experts pay attention to methods of purifying blood and other biological fluids. Lymph, blood, cerebrospinal fluid are “woven” from unformed plasma and cellular elements, which contain all substances transported throughout the body, incl. and toxins. Modern technologies make it possible to "calculate" the poisons in these streams and remove them from the body.

Scientific research and practice show that an increase in blood counts reduces the degree of possible thrombosis, improves blood microcirculation. It is well known, the so-called treatment with one's own blood - autohemotherapy.

Hemodialysis, an artificial kidney machine, is the first method that has become widespread. He helped to significantly reduce mortality from acute poisoning.

Modern developments in physical chemistry have proven the ability of finely porous carbon to retain many toxic substances and bacterial bodies. Based on this principle, sorption appeared. Enterosorption and colonosorption have proven themselves well. Hemosorption quickly gained popularity as an effective method of getting rid of various intoxications. Activated carbons have been replaced by ion exchange resins.

Based on knowledge about leukocytes, erythrocytes and other cellular elements, as well as plasma, where most of the poisonous elements “hide”, the idea of purifying blood through separation was born. The technique is called plasmapheresis. It allows you to get rid of many toxins, however, some amount of useful substances is also damaged.

Modern medicine knows many methods of detoxification by cleansing the lymph and cerebrospinal fluid. But due to the need for special manipulations, the indications for use are significantly narrowed. But for hemosorption and plasmapheresis, only special devices are required. Therefore, procedures can be performed on an outpatient basis.

Along with the methods of extracorporeal detoxification, photohemotherapy is used - the blood is irradiated with electromagnetic energy.

UROD - ultra-rapid opioid detoxification

The technique helps, by displacing the drug, to quickly “remove” opiates from the body. The process of "crowding out" takes place due to the introduction of a large amount of the antagonist. It has gained a reputation as one of the most reliable.

True, the procedure has one frightening factor - the removal of opioids from the body is accompanied by a well-known "breaking". Because of this, many drug addicts do not dare to undergo such a detoxification procedure. Due to the high speed of the course of biochemical processes, the withdrawal syndrome should be brought to a maximum. So that the patient does not experience suffering and does not include "brakes" in the activity of his nervous system, as a rule, general anesthesia is used. After recovery from anesthesia, the residual effects of the withdrawal syndrome in the patient disappear or barely appear. Their traces are "cleaned up" with drugs.

Thus, there are clear advantages of UROD compared to other methods of opioid detoxification.

Clinical picture

What doctors say about alcoholism

Doctor of Medical Sciences, Professor Ryzhenkova S.A.:

For many years I have been studying the problem of ALCOHOLISM. It's scary when a craving for alcohol destroys a person's life, families are destroyed because of alcohol, children lose their fathers, and their husbands' wives. It is young people who often become drunkards, destroying their future and causing irreparable harm to health.

It turns out that a drinking family member can be saved, and this can be done in secret from him. Today we will talk about a new natural remedy Alcolock, which turned out to be incredibly effective, and also participates in the Healthy Nation federal program, thanks to which until July 24th.(inclusive) the remedy can be obtained FOR FREE!

Withdrawal syndrome is absent or does not have a bright expressiveness, pain is not manifested. This allows it to be carried out without interrupting the rehabilitation course.
Supportive care can be used immediately after the patient has recovered from anesthesia.
A stable remission - from 70 to 90 percent - is observed for a long time, up to six months.
This detoxification technique is applicable to patients of any age, regardless of the duration of drug dependence and the doses used.

Modern methods of detoxification for drug addiction

Doctors select them based on the personal characteristics of the patient and examinations of the nature of intoxication. Therefore, they differ in relation to each drug addict, but have common directions:

medical;
non-drug;
combined.

Biological detoxification is based on natural, biological cleaning methods that use medications and chemicals that have side effects. The complex of procedures includes physical exercises, saunas, which stimulate the nervous system, increase sweating, blood circulation, “even out” breathing, etc. These detoxification techniques, similar to those used by our ancestors, help to remove toxins and metabolic products from the body.

This method of detoxification is considered quite effective, but since it involves high physical exertion, a qualified medical consultation is required at the beginning.

Drugs very painfully "hit" the patient's liver. Therefore, doctors pay special attention to this body. As a rule, treatment of cirrhosis of the liver is prescribed, enteral detoxification is performed.

By the way, such procedures are useful not only for drug addicts, but also for those who do not suffer from bad habits. Because the foods that people eat are “stuffed” with various food additives. The complex ecology and many other costs of modern human living conditions affect the liver, and it, in turn, affects the functioning of the body as a whole.

Thinking about their own health, many are ready to start cleaning the body, but not everyone knows where to start.

First of all, you need to contact the experts. They will help you create a detox program and prepare the necessary recommendations. Often, they suggest switching to an appropriate diet. She scares some people away. But for the sake of your own health, it is probably still worth going to certain restrictions.

The answer to this frequently asked question does not have a direct answer, as one would like to hear from someone who turns to a specialist with it.

The fact is that a person does not feel drug addiction until he begins to “withdraw”. Since society does not welcome such patients, then, as a rule, the patient not only does not want to officially contact a medical institution, but even consults a specialist.

But there is no other way than contacting a narcologist. Only a specialist can competently perform all the necessary actions:

accurately establish the fact of drug use and the degree of danger;
carry out a detoxification procedure, put a dropper;
eliminate depression, neurosis and panic disorder;
perform encoding;
perform a chemical blockade;
organize a psychiatric consultation at home.

However, treatment at home is associated with a number of difficulties. For example, there are limited opportunities in the examination and obtaining objective results of all necessary tests.

Detoxification: simple tricks to fix the problem

Bearing in mind that detoxification is the removal of toxins from the body, experts have developed simple recommendations for their removal from the body. We note right away that we are talking about cleaning the body with a low degree of slagging, which is focused on maintaining proper metabolism in natural ways and with the help of natural products.

The first thing to remember is that the body needs raw vegetables and fruits.

Second: it is necessary to limit as much as possible the use of heavy carbohydrates, which are contained in culinary products - fast foods, muffins and cakes.

Third: the menu should not contain fatty meat and fish.

And the last thing: from the liquid you need to give preference to filtered water and reduce the use of juices and "soda".

Well removes toxins and excess liquid rice, apple cider vinegar, regular watermelon.

By the way, there are products that, according to experts, help to speed up the removal of toxins and toxins from the body. Among them are parsley, apples, bananas, carrots, asparagus, beets, as well as lemon juice, oatmeal porridge and brown rice.

Secondly, detoxification of the body is more effective with an integrated approach. Therefore, even simple recommendations should not be ignored: all of a sudden, what seems like a trifle today will turn out to be just the very lifeline that will help return the most precious thing to the body - health!

Do not give up even the smallest chance.

Drawing conclusions

If you are reading these lines, we can conclude that you or your loved ones are somehow suffering from alcoholism.

We conducted an investigation, studied a bunch of materials and, most importantly, tested most of the methods and remedies for alcoholism. The verdict is:

All drugs, if they gave, then only a temporary result, as soon as the reception was stopped, the craving for alcohol increased sharply.

The only drug that has given a significant result is Alcolock.

The main advantage of this drug is that it once and for all removes cravings for alcohol without a hangover. In addition, he colorless and odorless, i.e. to cure a patient of alcoholism, it is enough to add a couple of drops of medicine to tea or any other drink or food.

In addition, now there is a promotion, every resident of the Russian Federation and the CIS can get Alcolock - FOR FREE!

Attention! Cases of sale of counterfeit drug Alcolock have become more frequent.
By placing an order using the links above, you are guaranteed to receive a quality product from the official manufacturer. In addition, when ordering on the official website, you receive a money back guarantee (including transportation costs) if the drug does not have a therapeutic effect.

In case of poisoning with toxic substances taken orally, a mandatory and emergency measure is gastric lavage through a tube. In a comatose state of the patient (in the absence of cough and laryngeal reflexes), in order to prevent aspiration, gastric lavage is performed only after preliminary intubation of the trachea with a tube with an inflatable cuff. In severe forms of poisoning, especially in patients in a coma, gastric lavage is repeated 3-4 times on the first or second day after poisoning due to a sharp decrease in resorption in the gastrointestinal tract, where a significant amount of unabsorbed toxic substance can be deposited. At the end of the first gastric lavage, a laxative should be introduced through the probe (100-150 ml of 30% sodium sulfate solution or 1-2 tablespoons of vaseline oil). In case of poisoning with caustic liquids, gastric lavage is carried out with small portions (250 ml each) of cold water after preliminary subcutaneous injection of 1 ml of 1% morphine solution and 0.1% atropine solution. Neutralization of acid in the stomach with an alkali solution is ineffective, and the use of sodium bicarbonate for this purpose is contraindicated because of the danger of gastric expansion by the resulting carbon dioxide. Laxatives for chemical burns of the stomach are not administered, almagel (50 ml) or vegetable oil emulsion (100 ml) is given orally.

For the adsorption of toxic substances in the gastrointestinal tract, activated charcoal with water is used in the form of gruel, one tablespoon inside in a total amount of 80-100 ml after gastric lavage.

The most accessible first aid measure for the intake of toxic substances through the mouth is to induce vomiting by irritating the root of the tongue and the back of the throat. The appointment of emetics (apomorphine) and the induction of vomiting in patients who are unconscious, as well as in case of poisoning with cauterizing poisons, are contraindicated because of the danger of their aspiration.

In case of contact with toxic substances on the skin, urgent washing of the skin with running water is necessary.

In case of inhalation poisoning, the victim should be immediately removed from the area of the affected atmosphere, the airways should be patency, free from clothing that restricts breathing, and oxygen should be inhaled. Medical personnel working in the area of the affected atmosphere must have protective equipment (isolating gas mask).

With parenteral administration of a toxic dose of drugs, cold is applied locally for 6-8 hours. 0.5-1 ml of 0.1% adrenaline solution is shown at the injection site. Tourniquets and local incisions are contraindicated.

When toxic substances are introduced into the cavities of the body (rectum, vagina, etc.), they are washed with plenty of water using an enema, douching, catheterization, etc.

To remove toxic substances from the bloodstream, various methods of artificial detoxification are used: non-invasive and surgical.

Forced diuretic as a dectosication method is based on the use of osmotic diuretics (urea, mannitol) and (or) saluretics (urea, manitol) and (or) saluretics (lasix, furosemide), which contribute to a sharp increase in diuresis. Forced diuresis allows you to speed up the elimination of toxic substances from the body by 5-10 times. The method is indicated for most intoxications, when the excretion of toxic substances is carried out mainly by the kidneys. The forced diuresis method includes three successive stages: water (liquid) loading, intravenous administration of diuretics and replacement infusion of an electrolyte solution.

Preliminarily, hypovolemia developing in severe poisoning is compensated by intravenous administration of plasma-substituting solutions (polyglucin, gemodez and 5% glucose solution in a volume of 1-1.5 l). In specialized departments, it is necessary to simultaneously determine the concentration of a toxic substance in the blood and urine, central venous pressure, hematocrit, and insert a catheter into the bladder to measure hourly diuresis.

A 30% solution of urea or a 15% solution of manitol is administered intravenously by stream for 10-15 minutes at the rate of 1-2 g of a dry preparation per 1 kg of the patient's body weight, lasix (furosemide) at a dose of 80-10 mg (8-10 ml of 1% solution). At the end of the introduction of diuretics, an infusion of an electrolyte solution with glucose (4-5 g of potassium chloride, 6 g of sodium chloride and 10 g of glucose in 1 liter of water) is started. The rate of intravenous administration of an electrolyte-glucose solution should correspond to the volumetric rate of diuresis, reaching 800-1200 ml / h. This cycle, if necessary, is repeated after 5 and up to the complete removal of the toxic substance from the bloodstream.

In the process of treatment by the method of forced diuresis and after its completion, it is necessary to control the content of electrolytes (potassium, sodium, calcium) in the blood, followed by compensation for the detected violations of the water and electrolyte status.

In the treatment of acute poisoning with barbiturates, salicylates and other chemicals, the solutions of which have an acidic urine reaction (pH over 8.0).

The method of forced diuresis is contraindicated in case of intoxication complicated by acute vascular insufficiency (persistent collapse), in the presence of chronic circulatory insufficiency (stages II-III), as well as in violation of kidney function (oliguria, azotemia, serum creatine level above 5 mg%). In patients older than 50 years, the effectiveness of the forced diuresis method is markedly reduced.

Hemodialysis using an "artificial kidney" machine is an effective method of treating poisoning with dialyzable toxic substances that are able to penetrate through the semi-permeable membrane of the dialyzer. Hemodialysis is used as an emergency measure in the early "toxicogenic" stage of intoxication, in special centers (departments) for the treatment of poisoning or "artificial kidney" departments. In terms of the rate of blood purification (clearance) from poisons, hemodialysis is 5-6 times higher than the method of forced diuresis.

A contraindication to the use of hemodialysis is acute cardiovascular failure (collapse), decompensated exotoxic shock.

Peritoneal dialysis is used to accelerate the elimination of toxic substances that have the ability to be deposited in adipose tissues or bind tightly to plasma proteins. The operation of peritoneal dialysis is possible in any surgical hospital by creating a fistula penetrating into the abdominal cavity and inserting a special catheter into it. Peritoneal dialysis in acute poisoning is carried out by an intermittent method. Dialysis fluid of the following composition is introduced through the fistula into the abdominal cavity: sodium chloride - 6 g, potassium chloride - 0.3 g, calcium chloride - 0.3 g, sodium bicarbonate - 7.5 g, glucose - 6 g per 1 liter of water. Sterile dialysis fluid is injected in the amount of 1.5-2 liters and every 30 minutes it is changed. A feature of this method is the possibility of its application without reducing the clearance efficiency even in cases of acute cardiovascular insufficiency, which compares favorably with other methods of accelerated elimination of toxic substances from the body.

Contraindications to the use of peritoneal dialysis are a pronounced adhesive process in the abdominal cavity and long gestation periods.

Hemosorption by perfusion of the patient's blood through a special column (detoxifier) with activated carbon or other sorbent is a new method for removing a number of toxic substances from the body, which can be carried out in a specialized hospital, as well as by a specialized toxicological ambulance team at the pre-hospital stage. The clearance of toxic substances during hemosorption is 5 times higher than during hemodialysis.

The operation of blood replacement (OZK) of the recipient with the blood of a donor is indicated in case of acute reactions with some chemicals that cause toxic damage to the blood: the formation of methemoglobin (aniline), a long-term decrease in the activity of cholinesterases (organophosphorus insecticides), massive hemolysis (arsenic hydrogen), etc. After replacement of 2- 3 liters of blood requires control and correction of its electrolyte composition and acid-base state. The effectiveness of OZK in terms of clearance of toxic substances is significantly inferior to all the above methods of active detoxification. The operation is contraindicated in acute cardiovascular insufficiency.

Specific (antidote) therapy retains its effectiveness only in the early "toxicogenic" phase of acute poisoning and can be used subject to a reliable clinical and laboratory diagnosis of the corresponding type of intoxication. Otherwise, the antidote may have a toxic effect on the body.

1. Methods for stimulating the body's natural cleansing processes:

Cleansing the gastrointestinal tract (gastric lavage);

Enterosorption;

forced diuresis;

Hyperventilation of the lungs;

Hyperbaric oxygenation;

intestinal lavage

Methods for enhancing the body's natural cleansing processes

Interruption of contact with a toxic environment is possible with inhalation poisoning. In this type of poisoning, the primary measure is the use of a gas mask and the removal of the victim from the toxic atmosphere to fresh air.

Washing off the toxic substance is necessary for percutaneous poisoning. Plentifully wash the skin with running water, remove the toxic substance, which interrupts its action. If poison gets into the eyes, it is also washed off on the conjunctiva.

Removal of toxic substances from the gastrointestinal tract. Gastric lavage is a simple and at the same time very effective procedure. allows in the early stages of intoxication to remove most of the poison from the body. The outcome of poisoning often depends not so much on the toxicity and amount of poison taken, but on how timely and efficiently the gastric lavage was done. Removal of poison from the stomach is carried out by washing it (by probeless and probe method).

Induction of vomiting (gastric lavage). (in order to provide first aid and in case of group poisoning). Subsequently, probeless washing must be supplemented with a probe.

For probe gastric lavage, at least 10 liters of clean water at room temperature or close to human body temperature is required. For probe gastric lavage, a simple device is used, consisting of a glass funnel with a capacity of 0.5 - 1.0 l with engraved divisions of 100 cm 3, connected to a thick-walled rubber tube 1 - 1.5 m long and about 1 - 1.5 in diameter. see. The patient sits with his legs apart. The dentures need to be removed. A funnel is put on the outer end of the probe, the other end is moistened with vaseline oil. The patient is asked to open his mouth and breathe deeply. The doctor is on the right; with a quick movement, he inserts the probe behind the root of the tongue. Next, the patient is asked to make swallowing movements after inhaling through the nose, during which the probe is carefully advanced. With the introduction of the probe to the first mark (40 cm from the end), the funnel is lowered. If the probe is in the stomach, then gastric contents enter the funnel. Otherwise, the probe is advanced further. Holding the funnel at knee level, fill it with water and slowly raise it above the level of the patient's mouth. When the funnel is empty, it is again lowered over the basin or bucket, where the contents of the stomach are poured.

The first portion of the wash water is collected for laboratory chemical analysis in a clean container with a capacity of up to 2 liters with a wide neck. The procedure stops after the appearance of clean washing water and the disappearance of the smell of poison in them. Before removing the probe, it is necessary to pinch it so that the liquid in it does not enter the respiratory tract.

In case of poisoning with long-metabolizing poisons (chlorinated hydrocarbons, FOS, methyl alcohol, ethylene glycol, narcotic substances, etc.), it is recommended to repeat gastric lavage every 4-6 hours for 2-3 days. The need for this is explained by the re-entry of a toxic substance into the stomach from the intestines as a result of reverse peristalsis and the reflux of bile containing poison into the stomach, as well as the ability to secrete toxic substances from the blood from the gastric mucosa.

With unskilled gastric lavage, the following complications may develop: aspiration of the lavage fluid; ruptures of the mucous membrane of the pharynx, esophagus and stomach; tongue injuries complicated by bleeding and blood aspiration. During the performance of this procedure by paramedical personnel, the participation or constant supervision of a doctor responsible for its safety is necessary.

Gastric lavage is contraindicated in case of suspected perforation of the stomach (esophagus) and massive internal bleeding. In the presence of psychomotor agitation and convulsions, it is first necessary to stop them, and then carry out gastric lavage.

After gastric lavage, it is recommended to inject various adsorbent and laxative agents into the mouth to reduce absorption and accelerate the passage of toxic substances through the gastrointestinal tract. Enterosorbents: carbolene, lignin, microsorb, used in a single dose of at least 50 g, then 20-40 g at intervals of 2-4 hours for 12 hours. Salt laxatives: magnesium sulfate, sodium sulfate, 25-30 g in 400 -800 ml of water. More effective is the use of vaseline oil (100-150 ml) as a laxative, which is not absorbed in the intestines and actively binds fat-soluble toxic substances, such as dichloroethane.

Along with laxatives, other methods of enhancing intestinal motility are used in clinical practice, in particular, cleansing and siphon enemas. Their detoxifying effect is limited by the time required for the passage of a toxic substance from the small intestine to the large intestine. Therefore, the early application of this method in the first hours of the effect does not give.

The most reliable way to cleanse the intestines from toxic substances is to wash it with the help of direct probing and the introduction of special solutions - intestinal lavage. The therapeutic effect of this method lies in the fact that it makes it possible to directly cleanse the small intestine, where, with late gastric lavage (2-3 hours after poisoning), a significant amount of poison is deposited, which continues to enter the bloodstream.

For complete cleansing of the intestines, the introduction of 500 ml of saline per 1 kg of the patient's body weight (25-30 liters in total) is required.

As complications, the development of symptoms of overhydration is possible with uncontrolled administration of fluid and injury to the mucous membrane of the stomach or duodenum with gross manipulation during the passage of the probe from the stomach to the intestine.

Thus, intestinal lavage is the most effective way to cleanse the intestines in acute poisoning, and its use in combination with blood purification methods provides the most rapid and lasting detoxification effect.

Forced diuresis - includes fluid loading, the introduction of osmotic diuretics (urea, mannitol) or saluretics (lasix, furosemide) and replacement infusion of electrolytes. The method is indicated for poisoning, in which the excretion of toxic substances is carried out mainly by the kidneys (barbiturates, salicylates, alkaloids). Contraindications for forced diuresis are collapse, anuria, a history of chronic renal failure, circulatory failure stage 2-3.

2. methods of artificial detoxification and physio-chemo-hemotherapy(intracorporeal and extracorporeal)

Blood replacement;

Plasmapheresis;

Lymph detoxification methods;

Hemo- (plasmo-) dialysis;

Ultrafiltration;

Hemofiltration;

Electrochemical oxidation of blood;

Hemodiafiltration;

peritoneal dialysis;

Hemo-(plasma-) sorption;

Ozone hemotherapy;

Laser irradiation of blood;

Magnetic blood treatment;

Ultraviolet betrothal of blood.

3. antidote detoxification methods:

Chemical antidotes::

contact action;

Parenteral action.

biochemical antidotes.

pharmacological antagonists.

Antitoxic immunotherapy.