[CLINICAL CASE OF ACUTE SEVERE COMBINED POISONING WITH NARCOTIC SUBSTANCES OF DEPENDENT AND PSYCHOSTIMULATING EFFECTS].

A case of acute severe concomitant poisoning with narcotic substances of depreciating and psychostimulating action (1,4 - butanediol, 1-phenyl-2- (1-pyrrolidinyl) -1-pentanone, methadone) complicated by the development of severe hypoxic-ischemic changes in the supratentorial white matter of the large brain is presented. edema and swelling of the brain, nosocomial focal left-sided lower lobe pneumonia in a 25-year-old patient. Psychoactive substances were used for hedonic purposes. Acute poisoning occurred after taking 100 ml of 1,4-butanediol together with phenyl-2- (1-pyrrolidinyl) -1-pentanone and 2 g of methadone, clinically manifested in the form of convulsive syndrome, depression of consciousness to the level of coma 3, edema and swelling brain, acute respiratory failure, mixed decompensated respiratory and metabolic lactic acidosis (pH 7.193; partial pressure of carbon dioxide 62.3 mm Hg, lactate 7.4 mmol / l) and complications in the form of nosocomial focal left-sided lower lobe pneumonia. Intensive therapy was of a complex nature, including infusion-detoxification therapy, correction of acid-base state disorders, hypoxic disorders, by using the substrate antihypoxant "Cytoflavin" in a daily dosage of 60 ml, for 15 days, against the background of basic infusion therapy and vasopressor support ... The clinical picture of acute poisoning, the features of its course, the data of radiological diagnostics and the effectiveness of pathogenetic approaches to intensive therapy are presented.

[Optimization of treatment of acute poisoning with severe psychodisleptics]. / Optimizatsiya lecheniya ostrykh otravlenii psikhodisleptikami tyazheloi stepeni.

OBJECTIVE: To increase the efficacy of acute poisoning with severe psychodisleptics. MATERIAL AND METHODS: Fifty-two patients with acute psychoactive substance poisoning were studied. Patients of the main group (n=27) received cytoflavin infusion in combination with inhaled sedation with sevoflurane in addition to conventional therapy. The comparison group consisted of 25 patients who received conventional therapy. RESULTS AND CONCLUSION: Augmentation of conventional therapy with cytoflavin in combination with inhaled sedation with sevoflurane, affecting various links in the pathogenesis of acute severe poisoning with psychodisleptics, made it possible to cope in a shorter time.

[Acute severe oral poisoning with 1,4-butandiol and ethanol with the development of coma]. / Ostroe tyazheloe peroral'noe otravlenie 1,4-butandiolom i etanolom s razvitiem komatoznogo sostoyaniya.

A case of acute oral poisoning by 1.4-butanediol, complicated by the development of severe hypoxia in a 34-year-old patient actively engaged in bodybuilding, is presented. The psychoactive substance was used by the patient to increase sexual activity and physical stamina. The duration of systematic daily intake was 4 months. The toxicogenic stage of acute poisoning was caused by a single dose of 50 ml of undiluted 13% 1.4-butanediol together with ethanol, manifested by convulsive syndrome, depression of consciousness to the level of coma II, acute respiratory failure with aspiration syndrome, respiratory acidosis (pH 7.22; partial pressure carbon dioxide 61.2 mm Hg), lactic acidosis up to 7 mmol / L, hyperammonemia up to 240 µmol / L, cerebral edema (decrease in white matter density to 21.6 ± 1.7 HU units), loss of vascular tone resistance (pareso arterioles) and a significant increase in cerebral blood flow rate to 115 ± 20.1 ml / 100 g per minute, increasing the volume of extracellular fluid (+ 130% of the proper volumes). Intensive therapy was complex, including infusion and detoxification therapy, correction of acid-base disorders, hypoxic disorders by using a substrate antihypoxant (Cytoflavin) in a daily dosage of 0.57 ml / kg body weight daily, for 9 days. The article discusses the toxicokinetics and toxicodynamics of 1.4-butanediol, radiation diagnostics and the clinical picture of acute poisoning, the features of its course, and pathogenetic approaches to therapy.

[Peculiarities of barbituric acid derivatives acute poisoning clinical picture in patients of elderly and senile age and their therapy.]

In this article materials obtained during treatment of 61 patients with acute poisoning with phenobarbital, which is part of Corvalol and Valocordin, are presented. It has already been established that phenobarbital acute poisoning in elderly and senile patients is accompanied by more frequent development of central nervous system, respiratory system (pneumonia) and cardiovascular system complications, which cause more severe clinical course and risk of an adverse outcome of acute poisoning. This research has shown that for hypoxia correction during phenobarbital acute poisoning in elderly and senile patients it is advisable to include Reamberin in the treatment regimen, which has no adverse effects on central haemodynamic parameters and effectively reduces severity of metabolic disorders.

[The delirium sindrome in a patient with acute poisoning by 1,4-butanediol]. / Razvitie delirioznogo sindroma pri ostrom otravlenii 1,4-butandiolom.

The article presents a case-report of delirium syndrome in a 29-year-old patient who systematically consumed 1.4-butanediol. Psychopathological symptoms developed in the toxicogenic phase and continued to increase during the first days of treatment, followed by transformation into a deliberate delirium and toxic nephropathy. Comprehensive treatment, including infusion-detoxification therapy, correction of acid-base and hypoxic disorders using cytoflavin, had a positive effect on the clinical course of poisoning and allowed for a favorable outcome of acute exogenous psychosis.

[[Features of Pharmacological Correction of Alcoholic Fatty Liver Disease in Patients with Acute Ethanol Intoxication].]

The aim of the study was to increase the efficiency of the treatment of acute ethanol intoxication in patients with alcoholic fatty liver disease. The article presents the results which received during the investigation and treatment of 166 patients with acute ethanol in- toxication on the background of alcoholic fatty liver disease Patients were assessed by the severity scale APACHE-Il. Were studied the dynamics of clinical, laboratory, biochemical parameters, the state of the antioxidant system activity and lipid peroxidation. The study found the effect of the combination hepatoprotective drug remaxol on the many links of metabolism, which was confirmed by the dynamics of biochemical parameters. There was a quick correction of hyperlactatemia, an effective reduction of ALT activity, the absence of reduction of albumin and urea concentration in the somatic period of ethanol poisoning. Period of using remaxol there was improvement in the clinical course of the disease, which manifested by the reduce the incidence of delirium tremens and shorten the duration of treatment of patients.

[The use of reamberin in combined intensive care of acute poisoning].

This review is focused on the substrate antihypoxant reamberin used in intensive therapy of acute poisoning with special reference to the mechanisms of its action consisting in the reduction of the severity of metabolic disorders manifested as a decrease of tissue hypoxia, recovery of antioxidant defense and suppression of the activity of lipid peroxidation and endotoxicosis. The antihyhypoxant activity of reamberin is apparent as the reduction of the hypoxic brain lesions in patients with acute poisoning which leads to a significant improvement in the clinical course of acute poisoning and decreases the number of adverse outcomes.

[Metabolic disturbances and ways of their pharmacological correction in acute poisoning with ethanol in patients with chronic alcoholism]. / Metabolicheskie narusheniia u bol'nykh s ostrymi otravleniiami étanolom na fone khronicheskogo alkogolizma i puti ikh farmakologicheskoi korrektsii.

AIM: To study an influence of chronic alcoholism on the clinical course and severity of metabolic disturbances in patients with acute poisoning with ethanol and to improve the treatment. MATERIAL AND METHODS: Authors examined 93 patients stratified into three groups (acute poisoning with ethanol in patients with chronic alcoholism, without chronic alcoholism and those treated with reamberin). RESULTS AND CONCLUSION: The presence of chronic alcoholism significantly augmented metabolic disturbances and influenced the disturbance of oxygen-transport function and free-radical processes in patients with acute intoxication with ethanol. Using of reamberin in the complex intensive therapy led to the decrease in metabolic disorders, which improved the clinical course of acute poisoning with ethanol in patients with chronic alcoholism.

[Correction of metabolic disorders during treatment of alcohol-induced liver injuries in patients with acute alcoholic intoxication].

A total of 103 patients with acute alcoholic intoxication were examined and treated for alcohol-induced hepatic lesions. It was shown that remaxol reduced severity of metabolic disorders associated with hypoxic conditions and active lipid peroxidation and thereby decreased the frequency of alcoholic delirium to 10.8% (n=7) compared with ademetionine (10.8%, n=22). Improvement of metabolism resulted in the reduction of stay in the intensive therapy ward by 5.6+/-0.3 and 7.3+/-0.6 days after remaxol and ademetionine therapy respectively). The total duration of treatment decreased by 9.0+/-0.4 and 11.8+/-1.1 days. The use of remaxol reduced the cost of the treatment by 21.7% compared with ademetionine.

[A case of favourable outcome of the treatment of extremely severe acute poisoning with methanol].

A case of favourable outcome of the treatment of extremely severe acute poisoning after prolonged exposure to lethal doses of methanol is reported. The complex treatment included urgent and effective elimination of the poison (multiple gastric lavage, hemodialysis), antidote therapy (administration of ethanol), correction of decompensated metabolic acidosis (alkali therapy and infusion therapy with reamberin). These measures had beneficial effect on the clinical course of poisoning and ensured its favourable outcome.

[Effect of cytoflavin on some physiological values in patients with toxicohypoxic encephalopathy].

The effect of cytoflavin upon bolus intravenous administration on the state of hemodynamic values and liquid sectors of the organism was studied in patients with toxicohypoxic encephalopathy caused by heavy acute poisoning. It is established that the bolus administration of cytoflavin is less effective than dropwise intravenous injection.

[Features of clinical way and treatment of old and senile patients with severe poisoning with carbon monoxide and the products of combustion].

The article presents the materials obtained in the course of treatment of 64 patients with severe poisoning with carbon monoxide and the products of combustion. It is established that acute carbon monoxide poisoning and combustion products in elderly and senile age is accompanied by more pronounced metabolic disorders, higher frequency of complications and lethality. Intensive therapy of severe poisoning with carbon monoxide has its own peculiarities. The use of Cytoflavin with antihypoxic purpose can lead to the development of metabolic desynchronization. To correct the hypoxic disorders in elderly and senile patients is more appropriate to use Reamberine, not having a negative effect on the indices of central hemodynamics and effectively reducing the depth of metabolic disorders.

[Pharmacologic correction of hypoxia in patients with acute cerebral failure due to acute poisoning with carbon monoxide and combustion products].

The article deals with the materials, which have been received in the process of the examination and treatment of 48 patients with acute severe carbon monoxide and burning products poisonings on fires. It has been registered that the including of citoflavin into the complex program of the intensive therapy of acute severe carbon monoxide and burning products poisonings on fires leads to a decrease of hypoxia and manifestations of acute toxicohypoxic cerebral deficiency, which significantly improves the clinics of acute severe poisonings.

[Pecularities of correction of alcohol affctions of liver in patients with acute ethanol poisoning in the setting of consequence of toxic effect of ethanol].

The aim of this work was to test the usage of infusion of hepatoprotector "remaxol" in intensive therapy of acute ethanol poisoning accompanied with severe alcohol affections of the lever. In the result of the examination and treatment of 130 patients it was established that severe alcohol poisonings registered on alcohol abused patients with toxic hepatopathy, are always accompanied with serious metabolic violations. In the process of a comparative valuation of the using of heptral (ademethionin) and remaxol in the intensive therapy of alcohol poisonings it has been revealed that the using of remaxol led to improvement of the clinic of that poisonings, what had been registered as a decrease of frequency and duration of an alcohol delirium from 33,9% to 10,8%, a decrease of frequency of secondary lung complication from 18,5 to 3,1%, a decrease of a duration of treatment in intensive care unit from 7,3 +/- 0,6 to 5,6 +/- 0,3 and a hospital treatment duration from 11,8 +/- 0,5 to 9,0 +/- 0,3 days. Biochemical investigation has shown that using as heptral, as remaxol led to improvement of lever damages due to alcohol. However remaxol compared with heptral was better in the treatment of metabolic violations.

[Comparative evaluation of clinical efficacy of drugs remaxol and ademetionine in patients with acute ethanol poisoning complicated by the toxic damage of the liver].

As a result of survey in process of treatment of 100 patients with severe acute poisoning of ethanol on the background of the toxic damage of the liver set that the severity of poisoning depends on the duration abuse of alcohol (Binge drinking). Inclusion in the intensive care infusion hepatoprotector remaxol compared with ademetionine leads to a faster dynamics of improvement of the patients condition, evaluated by the scale assessing the severity APACHE II. Also found, Use of remaxol can reduce development of complications such is alcoholic delirium on the background of long-term abuse of alcohol in percentage from 31.9% to 16%, as well as reduces the time of stay of patients in the departments of the resuscitation and intensive care unit from 7,3±0,6 to 5,6±0,3 days and duration of treatment of patients in the hospital from 11,8±1,1 to 9,0±0,4 days.

[Pharmacological correction of toxic liver damage in patients with heavy forms of acute ethanol intoxication].

The efficiency of using remaxol and ademethionine in the therapy of patients with heavy acute alcohol intoxication on the background of toxic liver damage has been studied. The administration of remaxol led to improvement of the clinical treatment of alcohol intoxication, which is manifested by a decrease in the rate and duration of delirium tremens (from 33.9 to 10.8%), frequency of secondary lung disorders (from 18.5 to 3.1%), duration of stay in hospital (from 7.3 +/- 0.6 to 5.6 +/- 0.3 days), and total therapy duration (from 11.8 +/- 1.05 to 5.6 +/- 0.3 days). The results of biochemical investigations confirmed that remaxol and ademethionine provide effective treatment of the toxic liver damage. Remaxol decreases the degree of metabolic disorders to a greater extent than does ademethionine.

[Correction of mnestico-intellectual disturbances in the somatogenic phase of acute poisoning with a mixture of psychotropic drugs].

A total of 60 patients suffering acute poisoning with a mixture of psychotropic drugs were available for observation. The study focused on comparative estimation of reintegration of psychic conditions (recovery of consciousness, conceptualization of mnestico-intellectual functions) in these patients. It was shown that intensive therapy of toxic and hypoxic brain lesions with antihypoxic agent cytoflavin results in rapid and effective reintegration of psychic activity including recovery of consciousness and conceptualization of mnestico-intellectual functions.

[Characteristics of the pharmacological treatment of toxic liver damage in patients with an alcohol abused syndrome and an acute severe ethanol poison].

The examination of 130 patients with an alcohol abused syndrome and a severe ethanol poison have revealed that ethanol action are accompanied by significant metabolic disturbances. The comparative evaluation of the inclusion of heptral and remaxol in the treatment has shown that remaxol improves the clinical course of mentioned disorders decreasing the frequency and duration of alcohol delirium. Patients treated with this drug spent less time in acute care and their treatment duration was shorter. Remaxol reduces more effectively the severity of metabolic disorders.

[Using of reamberin for correction of free radicals disturbances in patients with acute severe methadone poisonings].

The article deals with the materials, which have been received in the process of the examination and treatment of 44 patients with acute severe methadone poisonings. It has been revealed, that gravity of these patient's condition depends on intensity of hypoxia due to breath deficiency because of the methadone. The development of hypoxia, in its turn, cause violations of antiradical protection system and intensification of processes of peroxide lipid oxidation. It has been registered that the including of reamberin into the complex program of the intensive therapy of acute severe methadone poisonings lead to a more rapid restoration of antiradical protection system and to a decrease of activity of processes of peroxide lipid oxidation. The correction of hypoxia and free-radical violations led to improvement of the acute poisonings clinic, what had been characterized by a decrease of coma-period duration, duration of treatment with artificial lung ventilation, a decrease of secondary lung complications and a decrease of lethality.

[Features of clinical course and the experience using of reamberin in complex intensive therapy in patients with acute severe azaleptin poisonings].

This article deals with materials, which have been received in the process of an examination and treatment of 69 patients with acute severe azaleptin (leponeks) poisonings. On the base of clinic data the special features of clinic of acute severe azaleptin (leponeks) poisonings has been shown. It has been registered that the using of substrate antihypoxant reamberin in the intensive therapy of severe forms of acute azaleptin (leponeks) poisonings led to significant improvement of clinic manifestations, such as a coma period duration, a duration of artificial lung ventilation, a period of holinolitic psychiatric violations and a decrease of lethal poisonings.