Methods for detoxifying the body in acute poisoning
The treatment of any poisoning is reduced to removing the poison and neutralizing the effects of its effects on organs and tissues. The process of detoxification of toxins and acceleration of excretion from the body is called detoxification.
Currently, due 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 intestine), and on the use of various biological products and technical aids. Of no less importance is antidote therapy - the introduction of specific substances that transfer poison into an inactive state or neutralize its effect on the body.
What are the methods of detoxification
Methods of detoxification of the body are classified according to different signs.
- Natural and artificial, or conservative and active.
- By type of fluid to be purified - blood, intraperitoneal fluid, plasma, lymph.
- By the method of neutralizing the poison - antidote therapy, replacement transfusion, sorption methods (purification of blood and plasma), adsorption (binding of toxins in the intestine). Separately there are stimulating methods - strengthening of urination, the introduction of biologics for the work of the liver, the maintenance of the immune system.
The main procedures for the 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 irradiation of blood.
- Active methods of detoxification: peritoneal dialysis, hemosorption, hemodialysis, ultrafiltration of blood, hemofiltration, bio-artificial liver, exchange blood transfusion.
- Plasma - refer to modern methods of detoxification of the body: plasmapheresis, plasmosorption, plasmodialysis, cryoapheresis.
- Lymphatic methods of active detoxification: replacement of lymph, lymphosorption, lymphodialysis, lymphofiltration, lymphophoresis.
Some of them can be carried out at home, but most require special equipment. In acute poisoning, the following methods of excretion of the poison from the body are most common.
Adsorbents in the digestive tract
Some poisons are quickly absorbed from the stomach and intestines, while others partially remain there within a day. Toxins that have already passed from the stomach to the intestine, when an inverse peristalsis occurs (contractions of the muscular wall of the intestine) can be thrown back. Therefore, repeated washing of the stomach with adsorbent solutions is practiced, as well as adsorbents. These substances have the ability to bind most poisons and with them leave the body naturally. These include:
- Activated carbon;
- Polysorb MP;
- "Enterosorb" and others.
Adsorption of the poison in the gastrointestinal tract is the simplest and most effective method of detoxification in acute poisoning. Unfortunately, if untimely medical care or a large dose of poison occurs, a significant part of the toxins penetrates into 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 fluid, and then uses diuretics from the group of osmotic diuretics. The dose is selected individually. The rate of urination should be of the order of 500-700 milliliters per hour, in parallel, replenishment of fluid loss is performed. 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 for better dissolution of toxins, so the doctor prescribes the intravenous administration of appropriate drugs.
The method of forced diuresis is effective in case of poisons poisoning, which are 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, refers to the main methods of detoxifying the body. Dialysis is a biochemical process in which a substance passes from a solution with a higher concentration into a solution with a lower concentration. It is based on the ability of the peritoneum to work as a semipermeable membrane through which the poison enters the fluid from the abdominal cavity from the bloodstream.
Since the surface of the serous membrane lining this cavity equals about twenty square meters, the filtration process also proceeds at a good rate. To carry it to the abdominal wall, fix the fistula and insert a catheter through which 2 liters of a special solution is injected. The solution is replaced every half hour.
Peritoneal dialysis - 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 gland of the intestine. It is also effective for poisons that bind to blood proteins and lipids.
Hemodialysis is performed using the apparatus "artificial kidney." Applicable 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 poisonous 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 poison substance must meet several requirements: it is easy to dissolve in biological fluids, contain a significant concentration, do not bind to proteins and plasma lipids. Hemodialysis can not be used in case of persistent drop in blood pressure.
Hemosorption is one of the most common sorption methods of detoxification. A special preparation, called a detoxifier, is connected to the bloodstream of the patient. In this case, the blood is pumped through the columns with activated carbon and ion-exchange media, which absorb the poison.
The method has a drawback - during treatment, blood pressure is lowered, 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.
It is recommended hemosorption for poisoning with salicylates, poisonous fungi, barbiturates, phenothiazine derivatives, digitalis glycosides.
Exchange blood transfusion
This method of active detoxification of the body is prescribed in case of damage to enzyme systems, for example, when the production of cholinesterase is lowered by poisoning with organophosphorus drugs, or when blood coagulability is violated by hemolytic poisons. It is also effective to replace blood in case of intoxication with methaemoglobin and sulphmethemoglobin-forming agents.
Donor blood is injected in a volume of 4-5 liters, the same amount of blood is removed through the catheter from the femoral artery. The transfusion is carried out slowly, at a rate of no more than 50 milliliters per minute.
Hyperventilation of the lungs
When poisoning with volatile substances, forced breathing is used or, in another way, hyperventilation of the lungs. This method is effective in case of intoxication with gasoline, solvents for paints, alcohols, trichlorethylene, chloroform, acetone, carbon monoxide. These poisons are expelled with exhaled air. To perform the procedure, the patient is connected to the artificial respiration apparatus.
Modern medicine means there are many for carrying out detoxification of the body during poisoning. Natural or conservative methods, active or artificial, are used. In the first case, the physiological processes in the organs and tissues are accelerated, in the second case, special apparatuses or procedures are used to "extract" the poison from blood, plasma and other body fluids.