[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.

[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.

[INFLUENCE OF LIPOSUCTION OF LARGE VOLUME ON SYSTEMIC AND LUNG CIRCULATION, OXIGENATED LUNG FUNCTION].

The authors measured the changes of hemodynamics in 72 patients. It was also estimated a blood oxygenation and volume of liquid sectors of the organism in different degree of obesity before and after liposuction of the large volume. It was shown, that this operation facilitated to an improvement of respiratory lung function due to changes of pulmonary circulation.