Methods of detoxification of the body in acute poisoning
The treatment of any poisoning is reduced to the removal of poison and neutralizing the effects of its effects on organs and tissues. The process of neutralizing toxins and speeding up the elimination from the body is called detoxification.
Currently, thanks to numerous scientific discoveries in the field of molecular biology, there are the most modern methods of detoxification. They are based both on the acceleration of natural processes (urination, removal of poison from the intestines), and on the use of various biological preparations and technical means. Equally important is antidote therapy - the introduction of specific substances that translate the poison into an inactive state or neutralizing its effect on the body.
What are the methods of detoxification
Methods of detoxification of the body are classified according to various criteria.
- Natural and artificial, or conservative and active.
- By the type of fluid being cleaned - blood, intra-abdominal fluid, plasma, lymph.
- By the method of neutralization of poison - antidote therapy, replacement transfusion, sorption methods (purification of blood and plasma), adsorption (binding of toxins in the intestine). Separately, there are stimulating methods - increased urination, the introduction of biological preparations for the liver, the maintenance of the immune system.
The main procedures for phased detoxification of the body include the following procedures.
- Conservative: forced diuresis, gastrointestinal sorption (introduction of adsorbents - activated carbon and others into the stomach and intestines), ultraviolet blood irradiation.
- Active methods of detoxification: peritoneal dialysis, hemosorption, hemodialysis, ultrafiltration of blood, hemofiltration, bio-artificial liver, exchange transfusion.
- Plasma - refer to modern methods of detoxification of the body: plasma exchange, plasma adsorption, plasma dialysis, cryotherapy.
- Lymphatic methods of active detoxification: lymph replacement, lympho-sorption, lymphodialysis, lymph filtration, lymphoresis.
Some of them can be done at home, but most require special equipment. In acute poisoning the following methods are most common for removing poison from the body.
Adsorbents in the digestive tract
Some poisons are rapidly absorbed from the stomach and intestines, while others partially remain there during the day. Toxins that have already passed from the stomach to the intestines, in the event of reverse peristalsis (contractions of the intestinal muscular wall) can be thrown back. Therefore, repeated gastric lavage with adsorbing solutions, as well as the intake of adsorbents is practiced. These substances have the ability to bind most poisons and leave the body with them naturally. These include:
- Activated carbon;
- Polysorb MP;
- "Enterosorb" and others.
Adsorption of poison in the gastrointestinal tract is the simplest and most effective detoxification method for acute poisoning. Unfortunately, with the late delivery of medical care or the ingestion of a large dose of poison, a significant portion of the toxins penetrate the bloodstream and more serious procedures are required.
Forced diuresis refers to methods of enhancing natural detoxification by stimulating the work of the kidneys. The victim is injected with 1-2 liters of liquid, and then diuretics from the group of osmotic diuretics are used. The dose is selected individually. The rate of urination should be about 500-700 milliliters per hour, in parallel, carry out the replacement fluid loss. A positive effect is achieved with a daily urine volume of 5–8 liters.
In some cases, it is required to change the acidity of blood and urine to better dissolve toxins, so the doctor prescribes intravenous administration of the appropriate drugs.
The method of forced diuresis is effective in case of poisoning with poisons, easily excreted through the kidneys, and is not used for intoxication with fat-soluble substances and molecules that bind to proteins.
Peritoneal dialysis, or peritoneal lavage, is one of the main methods of detoxifying the body. Dialysis is a biochemical process in which a substance is transferred from a solution with a higher concentration to a solution with a lower concentration. It is based on the ability of the peritoneum to work as a semi-permeable membrane, through which the poison enters the bloodstream into the fluid of the abdominal cavity.
Since the surface of the serous membrane lining this cavity is of the order of twenty square meters, the filtration process occurs at a good speed. For its implementation, a fistula is fastened into the abdominal wall and a catheter is inserted through which 2 liters of a special solution are introduced. The solution is replaced every half hour.
Peritoneal dialysis is a long procedure, it takes about a day, sometimes more. The advantage of the method is that it removes toxins not only from the bloodstream, but also from tissues, for example, the omentum of the intestine. It is also effective for poisons that bind to blood proteins and lipids.
Hemodialysis is performed using an artificial kidney machine. Apply in the early period of intoxication with barbiturates, compounds of a number of metals and arsenic, salicylates, dichloroethane, ethylene glycol, isoniazid, quinine, methyl alcohol and other less common toxic substances.
In hemodialysis, blood is supplied to the apparatus, in which toxins are filtered through the pores of the cellophane membrane into a special liquid. The poisoning agent must meet several requirements: it is well soluble in biological fluids, contained in significant concentrations, and not bound to plasma proteins and lipids. Hemodialysis should not be used in case of persistent drop in blood pressure.
Hemosorption is one of the most common sorption methods of detoxification. A special drug called a detoxicator is connected to the patient’s bloodstream. At the same time, blood is pumped through a column with activated carbon and ion-exchange media that absorb poison through a pump.
The method has a disadvantage - in the process of treatment, blood pressure decreases, the number of platelets in the blood decreases. In addition, it is effective only if the toxin is in the bloodstream, but not in the cells of organs and tissues.
Hemosorption is recommended for poisoning by salicylates, poisonous fungi, barbiturates, phenothiazine derivatives, and digitalis glycosides.
Exchange blood transfusion
This method of active detoxification of the body is prescribed in the event of damage to enzyme systems, for example, when cholinesterase production is decreased when organophosphate drugs are poisoned, or if blood clotting is disturbed by hemolytic poisons. It is also effective to replace blood in case of intoxication with methemoglobin and sulfmethemoglobinoobrazovateley.
Donated blood is injected in a volume of 4–5 liters, the same amount of blood is removed through a catheter from the femoral artery. The transfusion is carried out slowly, at a rate of not more than 50 milliliters per minute.
Hyperventilation of the lungs
In case of poisoning with volatile substances, forced respiration is used, or in another way - hyperventilation of the lungs. This method is effective in the case of intoxication with gasoline, paint thinners, alcohols, trichlorethylene, chloroform, acetone, carbon monoxide. These poisons are expelled with exhaled air. For the procedure, the patient is connected to a respirator.
In modern medicine there are many remedies for detoxifying the body in case of poisoning. Apply natural or conservative methods, active or artificial. In the first case, physiological processes in organs and tissues are accelerated, in the second case, special devices or procedures are used to “extract” poison from the blood, plasma and other biological fluids of the body.