specific treatment. Principles of treatment of children with infectious diseases How allergen-specific therapy works

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The method of obtaining active immunity with the help of vaccines is called vaccination, and the resulting active artificial immunity is called post-vaccination. Vaccination carried out with a preventive purpose is called vaccinal prophylaxis and. The use of vaccines for therapeutic purposes is called vaccine therapy.
Currently, as vaccines for protective vaccinations, the following are used: 1) live vaccines; 2) vaccines from the bodies of killed microbes; 3) chemical vaccines prepared from certain components of bacterial cells; 4) toxoids made from bacterial exotoxins.
Live vaccines are obtained from microorganisms attenuated in their virulence. Without causing disease, live vaccines, however, reproduce in the body immunity to infection by virulent pathogens.
Vaccines from live microbes were obtained by various methods: long-term passage of a microbe through the body of a laboratory animal sensitive to this pathogen; long-term cultivation of bacteria on special nutrient media that are unfavorable for their development or with the addition of some substances (for example, bile); selection method and selection of laboratory strains.
In 1881, L. Pasteur developed a method for obtaining a live vaccine against anthrax, and in 1885 against rabies. In 1919, A. Calmette and C. Guerin in France received a weakened version of the tubercle bacillus, which is used to prevent tuberculosis. Live vaccines have also been obtained against other infectious diseases (plague, poliomyelitis, influenza, yellow fever). In terms of effectiveness, live vaccines are the most complete drugs, since
allow to successfully reproduce strong vaccination immunity where killed vaccines are ineffective.
Vaccines from killed microbes are made from cultures of pathogenic microbes killed either by thermal exposure, usually at a temperature of 56-58 ° for an hour (warmed vaccine), or by the action of chemicals (alcohol, formalin, merthiolate). Under the action of formalin, the following are obtained: 1) formol vaccines, in which microbes are killed by formalin, and 2) anavaccines made according to the principle of obtaining toxoids, that is, using the combined action of formalin and a temperature of 39-40 °.
Chemical vaccines are specific antigens of a certain chemical composition, which are obtained from bacterial cells by enzymatic digestion followed by precipitation with alcohol or extraction with an appropriate solvent (trichloroacetic acid). When properly prepared, full antigens have a very high immunizing property, but at the same time they can be toxic. Such a vaccine is the TABte chemical vaccine. This preparation is a mixture of precipitated complete antigens for simultaneous immunization against typhoid, paratyphoid A and B and purified concentrated tetanus toxoid.
In order to prolong the time of absorption of the vaccine and, consequently, to prolong the immunological irritation of the body to vaccines, non-specific substances that slow down absorption are added, such as calcium phosphate, alum, lanolin or vegetable oils.
These substances are called adjuvants (from the English. adjuvant - assistant), the effect of which is manifested not only in the fact that they retain the antigen at the injection site, but also significantly increase the synthesis of antibodies.
Anatoxins. In some diseases, when the exotoxin of the pathogen is of primary importance in pathogenesis, the vaccine is prepared from bacterial exotoxins. Anatoxin is an exotoxin, devoid of toxic properties, but retaining its antigenicity. To obtain it, 3-4% formalin is added to the exotoxin (see p. 130), kept in a thermostat at a temperature of 38-40 ° for 3-4 weeks, shaking periodically, purified and adsorbed on aluminum alum. The strength of the toxoid is determined by the method of flocculation and is indicated in immunogenic (antigenic) units (IU).
Toxoids are used for active immunization against diphtheria, tetanus, gas gangrene, botulism, recurrent pustular skin lesions of staphylococcal origin and for the production of antitoxic sera.
Types of vaccines. A vaccine that contains only one type of microbe is called a monovaccine (for example, an anti-typhoid vaccine), prepared from two microbes - a divaccine (from typhoid and paratyphoid bacteria). Polyvaccines contain a mixture of causative agents of many infectious diseases. Vaccines containing two or more pathogens are called associated vaccines. Associated vaccines can include not only microbes, but also toxoids, for example, pertussis-diphtheria-tetanus vaccine (DTP), consisting of diphtheria and tetanus toxoids and killed pertussis bacteria.
Autovaccines are monovalent vaccines prepared from a culture isolated from a patient and intended for his treatment. Autovaccine therapy aims to increase immunological reactivity. The same goal is pursued by autohemotherapy, in which blood is taken from a patient from a vein and injected into the gluteal muscle.
Preparation of killed vaccines. Killed vaccines are prepared in large microbiological institutes. The microbes from which the vaccine is prepared are inoculated into large flat agar bottles, the so-called mattresses. The culture grown on agar is washed off with saline and the resulting mother suspension is standardized, i.e., the required concentration of microbes is set (1 ml of the vaccine must contain a certain amount of microbial bodies). Titration of the vaccine (standardization) is performed by the optical method by comparing the opalescence (density) of the mother suspension with the standards.
Standardization of vaccines is carried out as follows. In an empty test tube, equal in diameter and wall thickness to the test tube of the standard, place 1 ml of the mother suspension. Then add as much saline as needed to bring the turbidity to that of the standard tube. For comparison, both test tubes are placed side by side in front of a light. For example, if 9 ml of physiological saline had to be added to 1 ml of the mother suspension in order to equate its density to the standard concentration of 1 billion, this means that 1 ml of the mother suspension contains 10 billion bacteria. Therefore, in order to prepare a vaccine with a titer of 1 billion, it is necessary to dilute the main suspension 10 times, with a titer of 2 billion - 5 times, etc.
The standard consists of 4 sealed test tubes - standards containing liquid of varying degrees of turbidity. The test tubes contain a suspension of the smallest pyrex glass particles, corresponding in size to bacteria. Standards are issued by the L. A. Tarasevich State Control Institute of Medical Biological Preparations. The standards indicate how many microbial bodies in 1 ml corresponds to the turbidity of this standard. The finished vaccine is mandatory checked for sterility and density by the local control laboratory and state control bodies. Ampoule labels indicate the name of the vaccine, the place and time of preparation, the number of microbes in 1 ml, the batch number, the state control number and the expiration date.
Vaccines should be stored in a cool, dry place. Typically, liquid vaccines are a whitish cloudy liquid that gives a slight precipitate that disappears when shaken. If the vaccine is not sterile, then the microbial bodies can lyse and the vaccine will be transparent or large flakes will form in it due to foreign microbes. Both in the first and in the second case, the vaccines are not suitable for consumption.
Vaccine administration methods and their dosage. Vaccines are administered to the body mainly by the parenteral route (bypassing the intestines). Vaccines against intestinal infections and toxoids are injected under the skin; smallpox, anthrax, tularemia - on the skin, tuberculosis (BCG vaccine) - intradermally, against poliomyelitis - enterally, influenza - through the nasal mucosa.
The effectiveness of vaccination depends on the correctness of administration, on the accuracy of dosing and compliance with revaccinations, and to a large extent on the general condition of the vaccinated.

SERUM

By subjecting animals, such as horses, to active immunization against a microbe or its exotoxin, sera can be obtained that have specific antimicrobial or antitoxic properties. Such a serum, administered to a person, creates immunity in his body to the kind of microbe or toxin that was used to immunize horses. Immunity is created in this case by introducing ready-made antibodies into the body, which is why it is called passive.
The use of immune sera for therapeutic purposes is called serotherapy, and for the purpose of prevention (which is less common) - seroprophylaxis.
There are two main types of therapeutic sera: 1) antitoxic and 2) antimicrobial.
Antitoxic sera are obtained by hyperimmunization of horses with small and then increasing doses of toxoid and toxin. With the accumulation of a sufficient amount of antibodies in the blood, partial or complete bloodletting is performed. The blood collected at the same time in special glass vessels is left for clotting. After a clear serum separates from the formed blood clot, a small amount of a preservative (chinosol, phenol, chloroform, etc.) is added to it. In order to remove from the serum ballast proteins that are harmful to the body, which are not antibodies, it is subjected to purification and concentration. These processes are based on the enzymatic digestion of non-immune whey proteins, followed by its purification by dialysis. Therefore, the sera purified by this method are called “d and a ferm”. Then the serum is kept at a temperature of 8 ° for 4-6 months and poured into ampoules. Before filling into ampoules, aged serum is tested for sterility, pyrogenicity (the ability to cause an increase in temperature), harmlessness and antitoxin content.
By titrating the obtained sera in an animal experiment, the antitoxic power of the serum is determined. The strength of the antitoxin is indicated by a conventional unit - the international unit (ME).
The international unit of antitoxin is the smallest amount of immune serum that neutralizes certain amounts of lethal doses of the toxin.
The healing power of antitoxic sera can also be determined in vitro using a flocculation test. Antitoxic serums include antidiphtheria, antitetanus, antigangrenous, etc.
Antimicrobial sera are obtained by hyperimmunization of animals with killed and live cultures of microbes or extracts from them, as well as lysates - products of dissolution of microbial cells. For immunization, strains with high immunizing and full antigenic properties are used.
Sera obtained by immunizing horses with one specific culture are called monovalent.
Sera obtained after treating a horse with several strains of the same microbe are called polyvalent. Antimicrobial sera include anti-plague, anti-anthrax, anti-influenza, anti-rabies.
Antitoxic serums are widely used for therapeutic purposes. Therapeutic antimicrobial sera are used less frequently. Antitoxic sera are prescribed in certain amounts of ME, antimicrobial - in milliliters. The amount of serum prescribed depends on the severity and day of the disease, the age of the patient. Serum is usually administered intramuscularly, in rare cases (with special indications) intravenously and intralumbally, against influenza - intranasally. Serum is injected fractionally according to the Bezredki method: at the beginning 0.1 ml, after 30 minutes - 0.5 ml and after 1.5 g of an hour the rest.
Medicinal sera, as well as other bacterial preparations intended for parenteral administration to humans, are tested at the L. A. Tarasevich State Control Institute for Medical Biological Preparations before they are released for use. The serum is supplied with a label, which indicates the name of the drug, where and when it was made, its quantity in the ampoule, titer, state control batch number and the expiration date of the drug must be indicated.
In order to prevent and treat certain diseases (measles, whooping cough, poliomyelitis), gamma globulins obtained from human placental blood are administered by special treatment (salting out, alcohol precipitation in the cold, etc.). This drug (gamma globulins), containing a sufficient amount of antibodies, is administered in a much smaller volume than serum.

Specific methods of treatment include the use of drugs whose action is directed to a single type of microorganism - therapeutic sera, immunoglobulins and gamma globulins, immune plasma, bacteriophages and therapeutic vaccines.

Therapeutic sera contain antibodies to microorganisms (antimicrobial sera) or to bacterial toxins (antitoxic sera - anti-botulinum, anti-gangrenous, anti-diphtheria, anti-tetanus) and are produced from the blood of immunized animals (the blood serum of immunized animals serves as a material for obtaining preparations of specific gamma globulins containing purified antibodies in high concentrations). titres (anti-leptospirosis, anti-anthrax, anti-tetanus, anti-plague).

Specific immunoglobulins are obtained from the blood of immunized donors or convalescents of infectious diseases (anti-rabies, anti-influenza, anti-diphtheria, anti-measles, anti-staphylococcal, anti-tetanus, anti-encephalic). Homologous immune preparations have advantages - they circulate in the body for a long time (up to 1-2 months) and do not have side effects. In some cases, blood plasma of immunized donors or convalescents (antimeningococcal, antistaphylococcal, etc.) is used.

Therapeutic sera, gamma and immunoglobulins are used only parenterally-intramuscularly, and in severe cases, intravenously. Since sera and gamma globulins obtained from animal blood contain heterologous (foreign) proteins, when they are administered, patients may develop immediate or delayed allergic reactions - anaphylactic shock, allergic dermatitis, Quincke's edema, serum sickness.

To prevent these complications, a preliminary desensitization of the body according to Bezredko is carried out, carried out by sequential subcutaneous administration of small portions of serum; then the entire dose of therapeutic serum is injected intramuscularly.

Patients receiving serotherapy should be under medical supervision for 1 hour.

In cases of a positive intradermal test or with the development of a reaction to subcutaneous administration of serum, the drug can be used only for health reasons and with desensitization. Also, with a positive serum sample, they can be administered under anesthesia or under the cover of large doses of glucocorticoids.

The opening of the ampoules and the introduction of serum is carried out under aseptic conditions. An opened ampoule with whole serum can be stored under a sterile napkin at room temperature for no more than 1 hour; ampoules with diluted serum are not stored.

Gammaglobulins are used according to the same rules.

Immunoglobulins are administered intramuscularly in the required dose without prior desensitization.

Before using sera and immunoglobulins, it is necessary to verify their suitability: the ampoule must be undamaged, clearly labeled with the appropriate expiration date, free of flakes and impurities. Immune preparations are stored in the refrigerator. Places of use of drugs should be equipped with an updated set of anti-shock agents.

Serums should be used in the early stages of the disease, before complications occur.

Bacteriophages are currently used mainly in intestinal infectious diseases as an additional treatment and on a limited scale. Pathogenic bacteria can belong to different phagotopimes, which makes it difficult to select the necessary bacteriophage individually. In response to the injected bacteriophage, antiphage antibodies are produced in the body. Bacteriophage preparations are available in tablets with an acid-resistant coating for oral administration (typhoid, dysentery, salmonella), in the form of suppositories (dysentery), in liquid form in vials (typhoid), in dry form in ampoules for dilution (staphylococcal, streptococcal, coliproteic, etc. .). Liquid forms of bacteriophages can be used orally, rectally and locally in the foci of inflammation - irrigation, tampons, lotions, subcutaneous and intramuscular injections. The drugs are used for 5-7 days, often repeated courses.

Vaccine therapy as a method of specific therapy for infectious diseases is aimed at specific stimulation of defense mechanisms. Vaccine preparations can be made from museum microbial strains or from a culture of pathogens isolated from a patient (autovaccine) in the form of a suspension of killed, inactivated microorganisms or their toxins devoid of pathogenic properties (anatoxins). Vaccines are used to treat chronic and protracted forms of infectious diseases, in which the development of immune mechanisms during the course of the infection is insufficient to free the body from the pathogen (chronic brucellosis, chronic dysentery, chronic toxoplasmosis, recurrent herpesvirus infection), and sometimes in acute infectious processes ( in typhoid fever for the prevention of bacterial carriage).

Vaccine therapy should be carried out in a hospital due to the risk of developing serious complications - a pronounced exacerbation of an infectious disease or activation of concomitant pathology, anaphylactic reactions, etc. Currently, vaccine therapy is giving way to new, more advanced and safe methods of immunotherapy.

Allergic reactions are considered one of the most common diseases in the modern world. Millions of people suffer from seasonal rhinitis, bronchial asthma and other life complicating diseases.

For decades, doctors have argued that allergies cannot be cured. But today there is ASIT - a treatment method that, if it does not cause a stable remission of the disease, then at least reduces the manifestations of an allergic reaction, improving the patient's quality of life.

• Show all

  What is Allergen Specific Therapy?

  To understand the principles of allergen-specific immunotherapy, you need to have an understanding of how an allergic reaction occurs.

  The word "allergy" can be translated from Latin as "another reaction." This is a state when the body of a particular person reacts to some substance in a different way than the bodies of other people do. Such a reaction is not typical for the normal functioning of the immune system of a healthy person. The answer to the question of why one person is allergic to cats, another is allergic to strawberries, and the third is not at all lies precisely in the principles of the immune system.

  At the first "meeting" with the allergen, immune memory cells record information about it, that is, a state of sensitization (hypersensitivity) to this substance sets in. With repeated and subsequent contacts, the immune system perceives the irritant-allergen as a potentially dangerous compound and induces an inflammatory cascade. Immune cells begin to produce various biologically active substances, which, acting on the body, cause sneezing, coughing, itching, rash, swelling and many other manifestations of allergies.

  All this significantly reduces the quality of life of an allergic person and forces them to look for any ways to reduce allergic manifestations or get rid of the disease, at least for a while. Just at this moment, ASIT comes to the rescue - allergen-specific therapy. She is also called:

  • allergen immunotherapy;
  • hyposensitizing therapy;
  • specific immunotherapy;
  • allergy vaccination.

  Regardless of the name, the essence of the method lies in the fact that specially processed preparations from the allergen that is the cause of the disease are introduced into the body. Over time, the sensitization of the body decreases, remission of the disease occurs and the symptoms become much less pronounced.

  The first mention of the use of allergen-specific therapy dates back to 1911. Every year, new allergen preparations appear and the list of available drugs for the treatment of diseases is expanding. The effectiveness of ASIT therapy is also beyond doubt: there is no need for the constant use of antiallergic drugs, the likelihood of developing severe allergic complications (Quincke's edema, anaphylactic shock) is significantly reduced.

  In some patients, remission lasts up to twenty years, and 5% of people who have completed a course of allergen-specific therapy get rid of the disease forever.

  Indications for therapy

  ASIT methods are used mainly in relation to those allergens, contact with which cannot be avoided.

  The therapy is more effective for treating allergies that are mild. With the onset of severe symptoms, when the patient has to constantly use antiallergic drugs, the likelihood of remission decreases sharply.

  

  Contraindications

  ASIT therapy is not applied:

  • in children under five years of age;
  • during an exacerbation of an allergic disease;
  • in persons with pathology of the cardiovascular system;
  • in patients with tuberculosis;
  • in patients with chronic liver or kidney disease;
  • in the presence of mental illness;
  • in patients with cancer and blood disorders.

  In the elderly, the question of the need for ASIT therapy is decided by the doctor, since after sixty years the immune system loses its plasticity and the effectiveness of treatment drops sharply.

  

  How is the treatment carried out

  The ASIT procedure is possible only by appointment and under the supervision of an allergist-immunologist, who determines the doses of the allergen and the duration of treatment.

  The main rule of therapy is not to treat during an exacerbation of allergies. If we are talking about hay fever (allergy to plant pollen), then allergen-specific therapy is carried out in the autumn-winter period and stopped before the start of the flowering season. In case of allergies to animals, dust and other allergens, treatment can theoretically be carried out all year round, if contact with the irritant is excluded.

  

  The therapy requires the following preparation:

  1. 1. To start treatment, you need to consult a doctor and conduct allergy tests. This will determine the exact type of irritant that causes a painful reaction, and use drugs of this particular allergen in the treatment.
  2. 2. It is necessary to be completely healthy. During colds or complications of some chronic pathology, allergen-specific therapy cannot be carried out.
  3. 3. Any antiallergic drugs should be stopped three days before the start of treatment.

  During ASIT therapy, it is important to strictly adhere to the doctor's prescriptions and carefully monitor the state of the body. After each introduction of the allergen, the patient should remain under the supervision of a doctor for at least an hour. It is even recommended to keep a diary of observations of your own health. In the event of any inadequate reactions, you should immediately seek qualified medical help.

  It is ideal to conduct allergen-specific therapy in a hospital. Sometimes the patient is offered to visit a day hospital.

  Treatment regimens

  There are two main treatment regimens:

  • classical;
  • abbreviated.

  The classic treatment regimen for allergen-specific therapy includes:

  1. 1. The initiation phase. During this period, the allergen preparation is administered, gradually increasing the dose to the maximum. This stage of treatment lasts at least four months.
  2. 2. Maintenance phase. At this stage, the maximum doses of the allergen are administered (three times a week with sublingual administration and once every 7-10 days with subcutaneous administration). The second period of therapy lasts from six months to several years.

  

  Therapy according to the reduced scheme of immunovaccination is carried out for mild forms of allergy. It is represented by the same two stages as the classical one. The only difference is the shortened initiation phase (about one and a half months).

  Treatment effectiveness

  One course of therapy allows you to get rid of allergies to one irritant. Pollinosis caused by allergy to the pollen of several plants can be treated with combined preparations of several allergens.

  Sometimes several courses of ASIT are needed for complete recovery, but in most patients, the effect of immunovaccination appears immediately. Repeated and subsequent courses of treatment are required in less than 30% of allergy sufferers.

  Types of drugs

  The allergen preparation is administered as a subcutaneous injection or sublingually (under the tongue) in the form of drops or tablets.

  It is believed that the sublingual administration of the allergen is more effective, because the irritating substance passing through the mucous membrane encounters a powerful immune response.

  

  Sublingual preparations have no age restrictions for use and are used in children from five years of age and adults.

  Injectable preparations are convenient for adults suffering from any chronic diseases, except for allergies, or pathology of the oral cavity.

  Concomitant Therapy

  To suppress allergic manifestations during the course of therapy, the patient may be prescribed:

  • antihistamines;
  • drugs against edema;
  • antipyretics and painkillers;
  • any other drugs as needed (when prescribing them, the doctor relies on the symptoms that have arisen).

  Cost of treatment

  Depending on the patient's region of residence and the type of allergen-specific therapy, the price of this procedure varies from 18 to 35 thousand rubles for three courses of treatment (standard duration).

  Treatment with injections is usually cheaper than with sublingual preparations, and children can receive ASIT therapy for free.

  Side effects

  Despite the obvious effectiveness of allergen-specific therapy, negative reactions can occur. They are divided into local and general (systemic).

  Local adverse reactions occur at the injection site of the allergen preparation and are expressed by redness, itching, burning or swelling.

  Systemic reactions occur regardless of the method and place of administration of the drug. They can be represented by angioedema or severe peripheral edema, anaphylactic shock, an attack of bronchospasm, pain in the joints and muscles, fever, headaches.

  The general condition of the patient during the course of therapy, as a rule, worsens. Characterized by weakness, malaise. This is due to the fact that the body is actively struggling with the introduced stimulus. This reaction is completely normal and disappears over time.

  To reduce the likelihood of unwanted effects, there are special prolonged (long-acting) allergen preparations.

  Due to the fact that they affect the immune system not only during but also after the procedure, they need to be administered much less often and in lower doses. This causes a very low percentage of adverse reactions to these drugs, so they are recommended for sensitive patients with poor health.

  

  Advantages and disadvantages

  Like any other treatment method, allergen-specific therapy has its pros and cons. The positive aspects of this method of treatment include:

  • reducing the risk of worsening allergic reactions and the development of severe pathologies (Quincke's edema, anaphylactic shock);

  Despite the existing shortcomings of allergen-specific therapy and contraindications to its use, this is one of the most effective means to combat allergic reactions. Moreover, only ASIT therapy allows you to treat allergies, and not just deal with its symptoms.

  ASIT therapy is the most effective means of improving the quality of life of allergy sufferers, which is suitable for the treatment of most patients.

Specific therapy for acute poisoning should be carried out in the following main areas:

Influence on the physico-chemical state of the poison in the gastrointestinal tract, for example, the use of sodium chloride in case of silver nitrate poisoning, enterosorption;

Specific chemical interaction with a toxic substance in the humoral environment of the body.

For example, the use of thiol and complexing substances (unithiol, EDTA) to obtain soluble compounds (chelates) with metals and accelerate their excretion in the urine;

Beneficial change in the metabolism of toxic substances in the body, for example, the use of ethyl alcohol in case of poisoning with methyl alcohol and ethylene glycol, which makes it possible to delay the formation of dangerous metabolites of these compounds in the liver (lethal synthesis);

Beneficial change in the biochemical reactions that substances enter into in the body, for example, the use of cholinesterase reactivators (dipiroxime) in case of poisoning with organophosphorus compounds;

Pharmacological antagonism in action on the same biochemical systems of the body, for example, between atropine and ezerin, which leads to the elimination of dangerous symptoms of poisoning by these drugs.

The most commonly used anti- (dots are presented in Table 13. p "

A drug

(antidote)

Activated

Alupent (Novodrin, Isadrin) Amyl nitrite in

Aminostigmine

0.1% Anexat solution 0.3 g Atropine, 0.1% solution

Acetylcystamine

Vitamin 5% solution

Vitamin C 5% solution

Vitamin K 1% solution Sodium bicarbonate 4% solution

Glucagon

Dipyroxime 15% solution, Dietixime 10% solution

Inhaled oxygen, hyperbaric Lipoic acid (20 mg/kg per day)

Mecaptide 40%

methylene

blue 1% solution

Naloxone 0.4% solution, nalorfin 0.5% solution

toxic substance

Medications, alkaloids, herbal poisons, organophosphorus compounds, chlorinated and aromatic hydrocarbons, higher and polyhydric alcohols

Adrenoblockers, clofe-

Benzodiazepine Amanita, pilocarpine, cardiac glycosides. organophosphorus compounds, clonidine, hellebore tincture Paracetamol, dichloroethane

Tubazid, fgivazid

Aniline, potassium permanganate, carbon monoxide

Indirect anticoagulants Acids

Antidiabetic

preparations (maninil, bucarban), beta-blockers

Phosphorus organic compounds (karbofos, chlorophos, etc.)

Carbon monoxide, carbon disulfide

Mushroom poison of pale toadstool

Arsenic hydrogen

Aniline, nitrites, nitrates

Opium preparations (morphine, codeine, etc.), promedol

A drug

(antidote)

Protamine-sul-

fat 1% solution

Anti-snake

specific

serum

Magnesium sulfate

30% solution

Tetacin-cal-

tions 10% solution

Sodium thiosulfate 30% solution

Unitiol 5% solution

Sodium chloride

2% solution Calcium chloride 10% solution

potassium chloride

0.5% solution Ezerin 0.1% solution

Ethyl alcohol:

30% solution inside

5% solution in a vein

toxic substance

Heparin Snake bites

Barium and its salts

Arsenic, cardiac glycosides, mercury salts, dichloroethane, carbon tetrachloride Aniline, benzene, iodine, copper, hydrocyanic acid, mercury salts, phenols Copper and its salts, arsenic, mercury salts, phenols, chromic acid

Nitrate silver

Anticoagulants, ethylene glycol, oxalic acid

cardiac glycosides

Amitriptyline, atropine

Methyl alcohol, ethylene glycol

Emergency assistance usually requires the development of a convulsive syndrome in case of poisoning with strychnine, amidopyrine, tubazid, organophosphorus insecticides, etc. First of all, the airway should be restored and 4-5 ml of a 2.5% solution of diazepam should be administered intravenously.

In convulsive conditions and toxic brain damage, hyperthermia syndrome may develop, which must be differentiated from febrile conditions in pneumonia.

In case of a convulsive state and toxic damage to the brain, ice should be put on the head and inguinal regions, a wet sheet wrap should be applied with simultaneous blowing with a fan. Intramuscularly - lytic mixture: 1 ml of 2.5% solution of chlorpromazine, 1 ml of 2.5% solution of diprazine (pipolfen) and 2 ml of 50% analgin.

Respiratory disorders in acute poisoning manifest themselves in several main clinical forms.

Aspiration-obturation form. Most often observed in a coma with blockage of the airways as a result of tongue retraction, aspiration of vomit, severe bronchorrhea and salivation. In these cases, it is necessary to remove the vomit from the oral cavity and pharynx with a swab, suck out the mucus from the pharynx with suction, remove the tongue with a tongue holder and insert the air duct. With pronounced salivation and bronchorrhea, 1 ml of a 0.1% solution of atropine is injected subcutaneously, if necessary, repeatedly. If asphyxia is caused by a burn of the upper respiratory tract and swelling of the larynx as a result of poisoning with cauterizing poisons, an urgent tracheostomy is necessary.

The central form of respiratory disorders develops against the background of a deep coma and is expressed in the absence or apparent insufficiency of independent respiratory movements. A similar picture of respiratory disorders is observed in case of poisoning with organophosphorus compounds and pachycarpine, when the decrease in independent respiratory movements is due to damage to the innervation of the respiratory muscles. In these cases, artificial, preferably hardware, breathing is necessary, which is best done after preliminary intubation, but it is also possible without it using a mask tightly pressed to the face.

The pulmonary form of respiratory disorders is associated with the development of pathological processes in the lungs (acute pneumonia, toxic pulmonary edema, tracheobronchitis, etc.). Toxic pulmonary edema occurs with burns of the upper respiratory tract with vapors of chlorine, ammonia, strong acids, as well as poisoning with phosgene and nitrogen oxides. With toxic pulmonary edema, 30-60 mg of prednisolone should be administered intravenously with 20 ml of 40% glucose solution (repeat if necessary), 100-150 ml of 30% urea solution intravenously or 80-100 mg of lasix, use oxygen therapy. In addition to the indicated treatment of pulmonary edema, aerosols are used (using an inhaler) with diphenhydramine, ephedrine, novocaine, antibiotics. In the absence of an inhaler, these same drugs should be administered parenterally at the usual dosages.

Acute pneumonia is a common cause of late respiratory complications from poisoning, especially in patients who have been in a coma or who have burned their upper respiratory tract with caustic chemicals. In this regard, in all cases of severe poisoning with impaired external respiration, early antibiotic therapy with broad-spectrum drugs and ultraviolet blood irradiation are necessary.

A special form of respiratory disorders in acute poisoning is hemic hypoxia due to hemolysis, methemoglobinemia, carboxyhemoglobinemia, as well as tissue hypoxia due to blockade of tissue respiratory enzymes in cyanide poisoning. Hyperbaric oxygen therapy and specific therapy are of great importance in the treatment of this pathology.

Violations of the function of the cardiovascular system. Early disorders of the cardiovascular system that develop on the first day after poisoning include toxic shock, which is observed in most severe acute intoxications. It is manifested by a sharp drop in blood pressure, tachycardia and shortness of breath, pallor of the skin. This is accompanied by decompensated metabolic acidosis. When examining blood and

hemodynamic parameters during this period, there is a change in the morphological composition of the blood (an increase in the number of red blood cells, an increase in hemoglobin and an increase in hematocrit), as well as a decrease in the volume of circulating blood and plasma, a drop in central venous pressure, a decrease in stroke volume of the heart, and an increase in peripheral vascular resistance.

In such cases, intravenous drip administration of plasma-substituting fluids (polyglucin, hemodez, glucose solutions, plasma) is necessary until the volume of circulating blood is restored and arterial and central venous pressure is normalized (sometimes up to 5-10 liters per day). To combat metabolic acidosis, 300-400 ml of a 4% sodium bicarbonate solution is injected intravenously.

In case of toxic burn shock caused by the action of strong acids and alkalis, in order to relieve pain, it is necessary to administer narcotic analgesics (1 ml of 1% morphine solution, 5 ml of 0.005% fentanyl solution), neuroleptics (1 ml of 0.25% droperidol solution), anticholinergics (1 ml of 1% atropine solution), as well as intravenous administration of glucosone-vocaine or polyglucinon-vocaine mixture: 30 ml of 2% novocaine solution per 500 ml of 5% glucose solution (polyglucin). If in the torpid phase of shock, despite infusion therapy, blood pressure remains low, it is advisable to administer intravenously 60-120 mg of prednisolone, adrenoceptor stimulants (dopamine, dobutrex).

In case of poisoning with poisons that primarily affect the heart (quinine, veratrin, barium chloride, verapamil, etc.), heart rhythm disturbances in the form of bradycardia and slowing of intracardiac conduction with the development of collapse can be observed. In such cases, along with other therapeutic agents, 1-2 ml of a 0.1% solution of atropine, 5-10 ml of 10% potassium chloride, 50 mg of prednisolone, tocopherol are administered intravenously.

In case of poisoning with organophosphate insecticides, an increase in the systolic ECG index above 15% is especially dangerous, which leads to the appearance of ventricular fibrillation.

Acute dystrophic changes in the myocardium are also severe complications of poisoning and are expressed the more clearly, the longer and more severe the intoxication is. The most severe clinical manifestation of these changes is the development of acute cardiovascular failure (collapse, pulmonary edema). At the same time, changes in the phase of repolarization are detected on the ECG. In the complex therapy of acute toxic myocardial dystrophy, drugs are used that improve metabolic processes (oxygen therapy, B vitamins, cocarboxylase, adenosine triphosphoric acid, etc.).

Kidney damage (toxic nephropathy) occurs when poisoned by nephrotoxic poisons (antifreeze, sublimate, dichloroethane, carbon tetrachloride, etc.), hemolytic poisons (acetic essence, copper sulphate), with deep trophic disorders with myoglobinuria (myorenal syndrome), as well as with prolonged and deep collapse against the background of other poisonings. Particular attention should be paid to the prevention of the possible development of acute renal failure.

The use of hemodialysis in the early period of acute poisoning with nephrotoxic poisons (mercuric chloride, mercury oxide, blue vitriol, arsenic, ethylene glycol, etc.) allows you to remove these substances from the body and prevent the development of kidney damage and other serious complications. In case of poisoning with hemolytic poisons and myoglobinuria, alkalization of plasma and urine has a good effect with simultaneous forced diuresis. Conservative treatment of acute renal failure is carried out under daily monitoring of the electrolyte composition of the blood, azotemia, urea in the blood and X-ray control of fluid retention in the lungs. In the complex of therapeutic measures, intravenous drip administration of a glucosone-vocaine mixture (300 ml of 10% glucose solution, 30 ml

2% solution of novocaine), as well as alkalization of the blood (through intravenous injection of 300 ml of 4% sodium bicarbonate solution). Indications for hemodialysis surgery are severe hyperkalemia, high blood urea levels (over 200 mg/dl), significant fluid retention in the body. ■"

Table 14. Symptoms of the most common poisonings and emergency care for them

Adrenaline (epinephrine, suprarenin). Neurotropic, psychotropic action. The lethal dose is 10 mg. Rapidly inactivated in the gastrointestinal tract. With parenteral administration - detoxification in the liver, excretion in the form of metabolites in the urine

White acacia (robinia). Roots and bark containing toxalbumin are poisonous. Gastroenterotoxic effect

Aconite (wrestler, blue buttercup, Issyk-Kul

root). The active principle is the alkaloid aconitine. Neurotoxic (curare-like, ganglion blocking), cardiotoxic action. Lethal dose - about 1 g of the plant, 5 ml of tincture, 2 mg of aconitine alkaloid

Symptoms of intoxication appear within the first 10 minutes after administration of the drug. Nausea, vomiting, pallor of the skin, cyanosis, chills, dilated pupils, blurred vision, tremor, convulsions, shortness of breath, coma. Tachycardia and initially a significant increase in blood pressure. Then its sharp decrease, fibrillation of ventricles is possible. Sometimes psychosis develops with hallucinations and a sense of fear Nausea, vomiting, tenesmus, abdominal pain, diarrhea. In severe cases - bloody stools, hematuria, acute cardiovascular failure

Nausea, vomiting, numbness of the tongue, lips, cheeks, fingertips and toes, crawling sensations, hot and cold sensations in the extremities, transient visual disturbances (seeing objects in green light), dry mouth, thirst, headache, restlessness, convulsive twitching of the muscles of the face, limbs, loss of consciousness. Breathing is rapid, shallow, difficult inhalation and exhalation, there may be a sudden cessation of breathing. Decrease in blood pressure (especially diastolic) In the initial stage - bradyarrhythmia, extrasystole, then - paroxysmal tachycardia, turning into ventricular fibrillation

1. When taken orally, gastric lavage. Forced diuresis.

2. Aminazin - 50-100 mg intramuscularly or intravenously.

3. With tachycardia - obzidan, inderal - 1-2 ml of a 0.1% solution intravenously repeatedly until a clinical effect is obtained

1. Gastric lavage, activated charcoal inside.

3. Intravenous administration 5-

10% glucose solution, 0.9% sodium chloride solution, electrolyte solution used in forced diuresis Cardiovascular agents, calcium chloride, vikasol 1. Gastric lavage, saline laxative, activated charcoal inside, forced diuresis, detoxification hemosorption.

3. Intravenously 20-50 ml of 1% novocaine solution, 500 ml of 5% glucose solution. Intramuscularly 10 ml of a 25% solution of magnesium sulfate. With convulsions - diazepam (seduxen) - 5-10 mg intravenously. In case of heart rhythm disorders - intravenously 10 ml of 10% solution of novocainamide (with normal blood pressure!) or 1-2 ml of 0.1% solution of obzidan. With bradycardia -0.1% solution of atropine subcutaneously. Intramuscularly cocarboxylase - 100 mg, 1% ATP solution -

2 ml, 5% ascorbic acid solution - 5 ml, 5% vitamin B solutions | - 4 ml, V^ - 4 ml

Alcohol

Aldehydes: formaldehyde acetaldehyde, paraaldehyde, metaldehyde.

Psychotropic (narcotic), neurotok-

See Ethyl alcohol, Alcohol surrogates

See Formalin

When taken orally - saliva - 1. Gastric lavage with water with ion, nausea, vomiting, pain in the stomach with the addition of bicarbonate of water, chills, drowsiness, tremor, sodium. tonic convulsions, coma, ug- 2. Forced diuresis.

3 - symptomatic therapy)

sic (convulsive), local irritant,

hepatotoxic effect. Absorbed through the mucous membranes of the respiratory tract and gastrointestinal tract. Excreted by the lungs and in the urine mainly in the form of non-toxic metabolites Aminazine (plegomazine, largactyl, chlorpromazine). Psychotropic, neurotoxic effect (gangliolytic, adrenolytic). The toxic dose is more than 500 mg. The lethal dose is 5-10 g. The toxic concentration in the blood is 1-2 mg/l, the lethal dose is 3-12 mg/l. Detoxification in the liver, excretion through the intestines and with urine - no more than 8% of the dose taken during

Amitriltyline (tryptizol), imizine (melipramine, imipramine, tofranil) and other tricyclic antidepressants. Psychotropic, neurotoxic (anticholinergic, antihistamine), cardiotoxic action. The toxic dose is 500 mg, the lethal dose is 1200 mg. Rapid absorption from the gastrointestinal tract. Binds to plasma proteins, partial metabolism in the liver, urinary excretion within 24 hours -

Amlodipine (Norvasc), verapamil. The general toxic effect is cardiovascular, hypotensive. These drugs are inhibitors

Severe weakness, dizziness, dry mouth, nausea. Perhaps the appearance of convulsions, loss of consciousness. The coma is shallow, tendon reflexes are increased, the pupils are constricted. Increased heart rate, lowering blood pressure without cyanosis. Skin allergic reactions. After leaving the coma, the phenomena of parkinsonism are possible. When chewing aminazine dragees, hyperemia and swelling of the oral mucosa occur, in children - a pronounced irritant effect on the mucous membrane of the digestive tract. In mild cases, dry mouth, blurred vision, psychomotor agitation, weakening of intestinal motility, urinary retention. Muscle twitching and hyperkinesis. In severe poisoning - confusion up to a deep coma, attacks of clonic-tonic convulsions of the epileptiform type. Disorders of cardiac activity: brady- and tachyarrhythmias, intracardiac blockade, ventricular fibrillation. Acute cardiovascular failure (collapse). Possible development of toxic hepatopathy, hyperglycemia, intestinal paresis

A sharp decrease in blood pressure due to a drop in peripheral vascular resistance is a primary toxic collapse. Perhaps the development of sinus bradycardia, violations of the internal

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1. Gastric lavage, saline laxative. Forced diuresis without plasma alkalinization. Physiohemotherapy.

3. With hypotension: 10% caffeine solution - 1-3 ml or 5% ephedrine solution - 2 ml subcutaneously; 6% vitamin B solution] -

4 ml intramuscularly. With parkinsonism syndrome: cyclodol 10-20 mg / day orally. Treatment of acute cardiovascular insufficiency

1. Repeated gastric lavage, forced diuresis. Hemosorption, physiotherapy

2.3. With tachyarrhythmia - 0.05% solution of prozerin - 1 ml intramuscularly or 0.1% solution of physostigmine - 1 ml subcutaneously again after 1 hour to a pulse rate of 60-70 per 1 min, lidocaine - 100 mg, 0.1% solution of in- derala - 1-5 ml intravenously. With bradyarrhythmia - 0.1% solution of atropine subcutaneously or intravenously again in an hour. With convulsions and arousal -

5-10 mg of diazepam intravenously or intramuscularly. Sodium bicarbonate solution 4% - 400 ml intravenously

1. Gastric lavage, intestinal lavage, enterosorption, sodium hypochlorite 0.06% - 400 ml intravenously, plasmapheresis. Physiohemotherapy.

Emergency care (1 - methods of active detoxification; 2 - antidote treatment;

3 - symptomatic therapy)

the entry of calcium ions into the cells of the myocardium and blood vessels. Metabolism 90% in the liver, half-life with urine - 36-48 hours Toxic dose - more than 100 mg Ammonia

Acdaxin (meprotan, meprobamate). Psychotropic, neurotoxic (central muscle relaxation),

antipyretic action. The lethal dose is about 15 g. The toxic concentration in the blood is 100 mg/l, the lethal dose is 200 mg/l. Rapidly absorbed from the gastrointestinal tract, excreted in the urine in - within 2-

Anestezin (benzocaine, ethylaminobenzoate). Ge-

motoxic (methemoglobin-forming)

action. A lethal dose of 10-15 g. Rapidly absorbed through the gastrointestinal tract, metabolism in the liver, excreted by the kidneys.

1.0 nickname

Aniline (amidobenzene "phenylamine). Psychotropic, neurotoxic, hemotoxic (methemoglobin formation, secondary hemolysis), hepatotoxic effect. Lethal dose when taken orally - 1 g. With the content of methemoglobin from total hemoglobin - 20- 30% symptoms of intoxication appear, 60-80% - lethal concentration.Intake through the respiratory tract, digestive tract, skin.

ventricular conduction, cardiac arrest. At the same time, stunning, stupor, convulsions are noted, in severe cases - coma with respiratory disorders, intestinal paresis, oliguria

See Caustic alkalis Drowsiness, muscle weakness, decreased body temperature.

In severe cases - coma, dilated pupils, decreased blood pressure, respiratory failure. See also Barbiturates

Bluish coloration of the mucous membranes of the lips, ears, nails due to acute methemoglobinemia. Severe weakness, dizziness, headache, euphoria with motor excitement, vomiting, shortness of breath. The pulse is frequent, the liver is enlarged and painful. In severe poisoning, impaired consciousness and coma quickly occur, the pupils are constricted, without reaction to light, salivation and bronchorrhea, hemic hypoxia. The danger of developing paralysis of the respiratory center and exotoxic shock. On the 2-3rd day of the disease, relapses of methemoglobinemia are possible,

2. Gluconate or calcium chloride 10% - 10 ml intravenously repeatedly, atropine 0.1% - 1 ml subcutaneously, glucagon - 2 mg intravenously.

3. Treatment of toxicogenic collapse (dopamine, dobutamine)

1. Gastric lavage, saline laxative. Forced diuresis without plasma alkalinization. With the development of a coma - peritoneal dialysis, hemodialysis, detoxification hemosorption. In case of severe respiratory disorders - artificial ventilation of the lungs

1. Gastric lavage through a probe, forced diuresis

with alkalization of the blood (sodium bicarbonate - 10-15 g orally).

2. Methylene blue - 1% solution of 1-2 ml per 1 kg of body weight with 250-300 ml of 5% glucose solution intravenously, 5% solution

1 In case of contact with the skin - washing with a solution of 1:1000 potassium permanganate. When ingested, abundant gastric lavage, the introduction of 150 ml of vaseline oil through a tube. Forced diuresis, hemosorption, hemodialysis

2 Treatment of methemoglobinemia"

1% solution of methylene blue, 1-2 ml per 1 kg of body weight with

5% glucose solution - 200-300 ml intravenously repeatedly. Ascorbic acid solution

5% - up to 60 ml per day intravenously. Vitamin B|2 - 600 mcg intramuscularly. Sodium thiosulfate 30% solution - 100 ml intravenously.

3. Treatment of exotoxic
metabolized with the formation of intermediate products that cause methemoglobin formation. It is deposited in adipose tissue, relapses of intoxication are possible. Excreted through the lungs, kidneys (paraaminophenol) Antabuse (teturam, disulfiram). Psychotropic, hepatotoxic action. Lethal dose: without alcohol in the blood - about 30 g, with a blood alcohol concentration of more than 1% - 1 g. Slowly absorbed from the gastrointestinal tract, slow excretion in the urine (in unchanged form). Leads to the accumulation in the body of acetaldehyde - the main metabolite of ethyl alcohol

Antibiotics (streptomycin, monomycin, kanamycin). Neurotoxic

some ototoxic effect

Direct acting anticoagulants - heparin

Indirect anticoagulants - neodicoumarin (pelentan), sincumar, phenylin, etc. Hemotoxic effect (blood hypocoagulation)

clonic-tonic convulsions, toxic anemia, parenchymal jaundice, acute liver and kidney failure

After a course of treatment with Antabuse, alcohol intake causes a sharp vegetovascular reaction - flushing of the skin, a feeling of heat in the face, difficulty breathing, palpitations, a feeling of fear of death, chills. Gradually, the reaction ends, and after 1-2 hours sleep sets in. After taking large doses of alcohol, a more severe reaction may develop - a sharp pallor of the skin, cyanosis, repeated vomiting, increased heart rate and a drop in blood pressure, signs of myocardial ischemia

Simultaneous ingestion of an ultra-high dose of antibiotics (over 10 g) can cause deafness due to damage to the auditory nerve (streptomycin) or oliguria due to renal failure (kanamycin, monomycin). These complications develop, as a rule, with a noticeable decrease in diuresis against the background of various infections with a lower daily dose of the drug, but its longer use. With increased sensitivity to antibiotics when using the usual therapeutic doses, anaphylactic shock may develop.

When injected into a vein, the action is immediate, into the muscle or under the skin - after 45-60 minutes. They are quickly absorbed from the gastrointestinal tract, the effect appears after 12-72 hours. They are excreted in the urine. Bleeding of the nose, uterine, stomach, intestines. Hematuria. Hemorrhages in the skin, scleral muscles, hemorrhagic anemia.

shock, acute hepatic and renal insufficiency. Oxygen therapy, hyperbaric oxygen therapy

1. When taking a toxic dose - gastric lavage, forced diuresis.

3. Lay the patient in a horizontal position. Intravenous infusion of 40% glucose solution - 40 ml with 5% ascorbic acid solution -

10 ml. sodium bicarbonate

4% solution - 200 ml intravenous drip. Vitamin B] 5% solution - 2 ml intramuscularly. Lasix - 40 mg intravenously. Cardiovascular agents

1. With hearing loss in 1-

3- and days after poisoning, hemodialysis or forced diuresis is indicated.

3. With oliguria on the first day, forced diuresis. Treatment of acute renal failure, „.

1. Removal of the victim from the danger zone. When poison enters - gastric lavage through a probe, vaseline oil inside - 200 ml. Forced diuresis, blood replacement surgery.

2. 30% solution of thiosulfate on-

Emergency care (1 - methods of active detoxification; 2 - antidote treatment; 3 - symptomatic therapy)

lungs, gastrointestinal tract. 15-30% is oxidized and excreted by the kidneys as metabolites, the rest is excreted unchanged through the lungs and in the urine. Possible deposition of benzene in erythrocytes, glandular organs, muscles, fatty tissue

Boric acid (borax), borax, sodium borate. Local (irritant), weak cytotoxic, convulsive effect. Lethal dose for adults - 10-20 g. Toxic concentration in the blood - 40 mg / l, lethal - 50 mg / l. Absorbed through the gastrointestinal tract, damaged skin. It is excreted by the kidneys unchanged and through the intestines within a week. Deposited in bone tissue, liver

Milestones are poisonous (hemlock, water hemlock, water omega). The rhizomes of the plant are most poisonous, especially in late autumn and early spring. Contains cicutotoxin. Neurotoxic (anticholinergic, convulsive) action. The lethal dose is about 50 mg of the plant per 1 kg of body weight.

Arsenic hydrogen (arsine) is a colorless gas with the smell of garlic. Neurotoxic, hemotoxic (hemolytic), hepatotoxic action. Lethal concentration in the air - 0.05 mg/l at expo-arrhythmic; lowering blood pressure. Bleeding from the nose and gums, hemorrhages into the skin, uterine bleeding are possible. When taking benzene inside - burning in the mouth, behind the sternum, in the epigastric region, vomiting, abdominal pain, dizziness, headache, agitation, followed by depression, coma, liver enlargement, jaundice (toxic hepatopathy). Possible chronic inhalation intoxication

Symptoms of intoxication develop 1-48 hours after ingestion. Abdominal pain, vomiting, diarrhea, general weakness, headache. Dehydration of the body, loss of consciousness, generalized twitching of the muscles of the face, limbs, convulsions. Cardiovascular insufficiency. Possible damage to the liver and kidneys. Children are especially susceptible to poisoning.

Rapidly absorbed from the gastrointestinal tract. The initial symptoms of poisoning appear after 1 */2-2 hours, sometimes after 20-30 minutes. Salivation, nausea, vomiting, abdominal pain, dilated pupils, tachycardia, tonic-clonic convulsions, collapse. Most often, poisoning develops in children, who usually eat rhizomes, mistaking them for carrots.

In case of poisoning with low doses, the development of its symptoms is preceded by a latent period of about 6 hours, with severe intoxication, the latent period is less than 3 hours. General weakness, nausea, vomiting, chills, anxiety, headache, paresthesia in the extremities, suffocation. Through 8 tria - 200 ml intravenously.

3. Intramuscularly vitamins B 6 and B) - up to 6 ml of 5% solutions, vitamin B12 - up to 1000 mcg / day (do not administer B vitamins at the same time). Cardiovascular agents. Ascorbic acid - 10-20 ml of 5% solution with 5% glucose solution intravenously. oxygen inhalation. With bleeding - 1% solution of vikasol intramuscularly up to 5 ml

1. Gastric lavage through a probe. Forced diuresis. Hemodialysis for severe poisoning

3. In the muscle - riboflavin mononucleotide - 10 mg per day. Correction of water-electrolyte balance and acidosis: infusion of sodium bicarbonate solution, plasma-substituting solutions, glucose, sodium chloride For abdominal pain -

0.1% solution of atropine - 1 ml,

0. 2% solution of platyfillin -

1 ml, 1% solution of promedol -

1 ml subcutaneously. Novocain - 2% solution - 50 ml with 5% glucose solution - 500 ml intravenously. Cardiovascular agents

1. Gastric lavage through a probe, saline laxative, activated charcoal inside, hemosorption.

3. With convulsions - diazepam 5-10 mg intravenously. Artificial hardware respiration. With a heart rhythm disorder - 10 ml of a 10% solution of novocainamide intravenously

1. Early hemodialysis. Blood replacement operation.

2. Mecaptide 40% solution -

1-2 ml every 4 hours with a 0.25% solution of novocaine intramuscularly for the first 2 days, then

2 times a day up to 5-6 days, after which - unithiol 5% solution - 5 ml 3-4 times a day.

position 1 h, at a concentration of 5 mg / l several breaths lead to death

Vitamin 0 2 (ergocalciferol, calciferol). Violation of calcium and phosphorus metabolism in the body, cytotoxic (membrane), nephrotoxic effect. Toxic dose at a single dose -

1,000,000 IU - 25 mg (20 ml oil solution, 5 ml alcohol solution). Vitamin B is metabolized in the liver and kidneys with the formation of active metabolites that cause the toxicity of the drug. accumulates in the body

Cardiac glycosides: preparations of various types of foxglove (the active principle is glycosides digitoxin, digoxin), adonis, lily of the valley, jaundice, strophanthus, hellebore, sea onion, etc. Cardiotoxic effect. They are quickly absorbed in the gastrointestinal tract, with intra-12 hours - hemoglobinuria (red or brown urine), cyanosis, convulsions, impaired consciousness are possible. On the 2-3rd day - toxic hepatopathy, nephropathy, hemolytic anemia

Intoxication can develop as a result of a single dose of a large dose of the drug or with repeated consumption (sometimes instead of sunflower oil), in children - as a result of exceeding the course preventive and therapeutic doses.

Nausea, repeated vomiting, dehydration, malnutrition, lethargy, fever, general adynamia, muscle hypotension, drowsiness, followed by severe anxiety, tonic-clonic convulsions. Increased blood pressure, muffled heart sounds, sometimes rhythm and conduction disturbances. Hematuria, leukocyturia, proteinuria, azotemia, acute renal failure. Hypercalcemia (serum calcium content up to 20 mg/dL or more), hypercholesterolemia, hyperphosphatemia, hyperproteinemia. X-ray of tubular bones reveals osteoporosis of the diaphyseal part. Possible metastatic calcification of the kidneys, myocardium, heart valves, vascular wall

Dyspeptic disorders (nausea, vomiting). Bradycardia, ventricular and atrial extrasystoles, conduction disturbances, various types of tachycardia, ventricular fibrillation and fibrillation. Drop in blood pressure, cyanosis, convulsions, blurred vision, mental disorders, loss of consciousness glucose - 200-300 ml, aminophylline

2.4% solution - 10 ml, sodium bicarbonate 4% solution - 100 ml intravenously. Forced diuresis. Cardiovascular drugs 1. When taking a high dose - hemodialysis, detoxification hemosorption.

3. Hydrocortisone - 250 mg / day or prednisone - 60 mg / day intramuscularly. Thyrocalcitonin - 5 IU 2-3 times a day, vitamins A (oil solution) 30,000-50,000 IU 2 times a day intramuscularly. Tocopherol (vitamin E) 30% solution - 2 ml intramuscularly 2 times a day. Cardiovascular agents. With an increase in blood pressure - 1% dibazol solution, 2-4 ml intramuscularly. Calcium disodium salt of EDTA, 2-4 mg per 500 ml of 5% glucose solution intravenously. Glucose 40% - 20 ml with insulin - 8 units, isotonic sodium chloride solution, plasma and plasma-substituting solutions

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Emergency care (1 - active detoxification methods, 2 - antidote treatment,

3 - symptomatic therapy)

irritant effect Lethal dose when taken orally - 15-

20 ml Toxic concentration in the blood - traces of dichloroethane, lethal - 5 mg / l Rapidly absorbed through the gastrointestinal tract, respiratory tract, skin After ingestion, the maximum concentration in the blood is reached in the first 6 hours, the absorption rate increases when taken together with alcohol and fats Metabolized in the liver with the formation of toxic metabolites of chloroethanol and monochloroacetic acid Deposited in adipose tissue Excreted with exhaled air, urine, feces

Zamaniha (Sem Araliaceae) Rhizomes and roots contain saponins, traces of alkaloids and glycosides, essential oil Produced as a tincture with 5% alcohol Cardiotoxic, local irritant, psychotropic (stimulating) effect

Isoniazid (isonicotinic acid hydrazide, tubazide) and its derivatives (ftivazide, saluzide, etc.) Neurotoxic (convulsive) effect Lethal dose - 10 g Rapidly absorbed from the gastrointestinal tract, maximum blood concentration - 1-3 hours after administration 50-75% of the drug in acetylated form is excreted in the urine within 24 hours, 5-10% - through the intestines

psychomotor agitation, coma, exotoxic shock (1 -

2nd day), on the 2nd-3rd day - toxic hepatopathy (pain in the right hypochondrium, liver enlargement, jaundice), nephropathy, hepatic-renal failure, hemorrhagic diathesis (gastric, nasal bleeding) In case of inhalation poisoning - headache, dizziness, drowsiness, dyspeptic disorders, increased salivation, toxic hepatopathy, nephropathy In severe cases - coma, exotoxic shock In contact with the skin - dermatitis, bullous rashes

See Atropine

When using a toxic dose - nausea, repeated vomiting, loose stools, bradycardia, dizziness, anxiety, a decrease in blood pressure is possible Bradyarrhythmia, ventricular extrasystole

Nausea, vomiting, abdominal pain, weakness, headache, paresthesia, dry mouth, tremor, ataxia, shortness of breath, bradycardia, then tachycardia In severe poisoning, epileptiform convulsions with loss of consciousness and respiratory distress Development of toxic nephropathy, hepatope is possible - ti in the first 3 days

3 In deep coma - intubation, artificial respiration Cardiovascular drugs Treatment of toxic shock In the 1st day - hormone therapy (prednisolone up to 120 mg intravenously repeatedly) Vitamin therapy Bc - up to 1500 mcg, B | - up to 4 ml of a 5% solution intramuscularly, B] 5 - up to 5 g orally Ascorbic acid - 5-10 ml of a 5% solution intravenously Tetacin-calcium - 40 ml of a 10% solution with 300 ml of a 5% glucose solution intravenously Unithiol -

5% solution of 5 ml intramuscularly repeatedly Lipoic acid - 20-30 mg / kg intravenously per day Antibiotics (levomycetin, penicillin) With a sharp excitation - 2 ml

2.5% pipolfen solution intravenously Treatment of toxic nephropathy and hepatopathy is carried out in a hospital

See Atropine

1 Gastric lavage through a tube Forced diuresis

3 Atropine - 1 ml of a 0.1% solution intravenously repeatedly until the relief of bradycardia

1 Gastric lavage through a tube, saline laxative Forced diuresis with blood alkalization Detoxification hemosorption

2 Vitamin - 5% solution, 10 ml intravenously repeatedly

3 For convulsions - 2 ml of a 2.5% solution of diazepam - intravenously Correction of acidosis -

4% sodium bicarbonate solution - 1000 ml in a vein

Fan, osciu9)> k ^ ho

Emergency care (1 - methods of active detoxification; 2 - antidote treatment; 3 - symptomatic therapy)

Indian hemp (hashish, plan, marijuana, marijuana)

Insulin. Hypoglycemic action

Iodine. Local cauterizing effect. Lethal dose - about 3 g

Potassium permanganate. Local cauterizing, resorptive, hemotoxic (methemoglobinemia) action. The lethal dose for children is about 3 g, for adults -

0.3-0.5g/kg

Strong acids: inorganic (nitric, sulfuric, hydrochloric, etc.), organic (acetic, oxalic, etc.). sorrel

Initially, psychomotor agitation, dilated pupils, tinnitus, vivid visual hallucinations, then - general weakness, lethargy, tearfulness and a long, deep sleep with a slow pulse and a decrease in body temperature. Active only with parenteral administration. In case of an overdose, symptoms of hypoglycemia occur - weakness, increased sweating, hand tremors, hunger. In severe poisoning (blood sugar level below 50 mg%) - psychomotor agitation, clonic-tonic convulsions, coma. When leaving a coma, prolonged toxic encephalopathy (schizophrenia-like syndrome) is noted. Inhalation of iodine vapor affects the upper respiratory tract (see Chlorine). When concentrated solutions of iodine get inside, severe burns of the digestive tract occur, the mucous membrane has a characteristic color. Possible development of hemolysis, hemoglobinuria

When ingested, there is a sharp pain in the mouth, along the esophagus, in the abdomen, vomiting, diarrhea. The mucous membrane of the oral cavity and pharynx is edematous, dark brown, purple. Laryngeal edema and mechanical asphyxia, burn shock, motor excitation, convulsions are possible. Often there are severe pneumonia, hemorrhagic colitis, nephropathy, hepatopathy, parkinsonism phenomena. With reduced acidity of gastric juice, methemoglobinemia is possible with severe cyanosis and shortness of breath.

When ingested, a chemical burn of the oral cavity, pharynx, pharynx, esophagus, stomach, and sometimes intestines develops: a sharp pain in the oral cavity, along the pi-

Gastric lavage in case of ingestion of poison, forced diuresis. With a sharp excitation - 4-5 ml of a 2.5% solution of chlorpromazine intramuscularly

1. Forced diuresis with alkalization of the blood.

2. Immediate intravenous administration of a 20% glucose solution in the amount necessary to restore normal blood sugar levels. Glucagon - 0.5-1 mg intramuscularly.

3. With a coma - adrenaline -

1 ml of 0.1% solution subcutaneously. Cardiovascular agents

1. Gastric lavage through a probe, preferably with 0.5% sodium thiosulfate solution.

2. Sodium thiosulfate 30% solution - up to 300 ml per day intravenously, 10% sodium chloride solution - 30 ml intravenously.

3. Treatment of burns of the digestive tract (see Strong acids)

1. See strong acids.

1. With a sharp cyanosis (methemoglobinemia) - methylene

blue - 50 ml of 1% solution, ascorbic acid - 30 ml of 5% solution intravenously.

3. Vitamin therapy: B, up to 1000 mcg, B 6 - 3 ml of a 5% solution intramuscularly. Treatment of toxic nephropathy, hepatopathy in a hospital

1. Washing the stomach with cold water through a probe lubricated with vegetable oil. Before gastric lavage - subcutaneously morphine - 1 ml of 1% solution

Emergency care (1 - active detoxification methods, 2 - antidote treatment, 3 - symptomatic therapy)

acid is part of a number of household chemicals used to remove rust (liquids, pastes, powders). Local cauterizing effect (coagulative necrosis), hemotoxic (hemolytic) and nephrohepatotoxic - for organic acids. Lethal dose - 30-50 ml

Clonidine (hemiton, clonidine, katapresan) Psychotropic and cardiotoxic action, obeschevoda, in the abdomen. Significant salivation, repeated vomiting with an admixture of blood, esophageal bleeding Mechanical asphyxia due to burns and swelling of the larynx. Phenomena of toxic burn shock (compensated or decompensated). In severe cases, especially in case of poisoning with vinegar essence, hemolysis, hemoglobinuria are observed (urine becomes red-brown, dark brown), by the end of the first day, yellowness of the skin and sclera appears. Against the background of hemolysis, toxic coagulopathy develops (a short-term phase of hypercoagulability and secondary fibrinolysis). On the 2nd-3rd day, the phenomena of endogenous toxemia prevail (fever, agitation), the phenomena of reactive peritonitis, pancreatitis, then the phenomena of nephropathy against the background of acute hemoglobinuric nephrosis (with acetic acid poisoning), hepatopathy, infectious complications (purulent tracheobronchitis, pneumonia) . On the 2-3rd week, late esophageal-gastric bleeding can be a complication of burn disease. By the end of the 3rd week, with severe burns (ulcerative necrotic inflammation), there are signs of cicatricial narrowing of the esophagus or, more often, the outlet section of the stomach (in case of poisoning with inorganic acids). Ulcerative necrotic gastritis and esophagitis often become chronic

Dizziness, weakness, mi-

oz, stunning with a disorder of orientation and memory (retrograde amnesia). Rapid solution and atropine - 1 ml of 0.1% solution, forced diuresis with alkalization of the blood. Swallow ice cubes.

2. The introduction of a 4% solution of sodium bicarbonate up to 1500 ml into a vein with the appearance of dark urine and the development of metabolic acidosis.

3. Treatment of burn shock. Poliglyukin - 800 ml intravenous drip. Glyukozonovokaina - a new mixture (glucose - 300 ml

5% solution, novocaine - 30 ml

2% solution) intravenously drip Papaverine - 2 ml of 2% solution, platifillin - 1 ml

0.2% solution, atropine - 0.5-

1 ml of 0.1% solution subcutaneously up to 6-8 times a day. Cardiovascular agents (cordiamin -

2 ml, caffeine - 2 ml 10% ras

creation subcutaneously). With the development of bleeding - ice inside. In cases of significant blood loss - repeated blood transfusion. Antibiotic therapy. Hormone therapy: hydrocortisone - 125 mg, AHTG - 10 IU intramuscularly per day. For local treatment of the burned surface, almagel with anestezin is given inside after 3 hours. Vitamin therapy: - 400 mcg,

2 ml of 5% solution, V^

2 ml of a 5% solution intramuscularly (do not administer at the same time). Treatment of toxic nephropathy, hepatopathy - in the hospital. For the treatment of toxic coagulopathy after bleeding stops - heparin up to 30,000-60,000 IU per day intravenously or intramuscularly for 2-3 days (under the control of a coagulogram). With laryngeal edema - inhalation of aerosols: novocaine - 3 ml of a 0.5% solution with ephedrine - 1 ml of a 5% solution or adrenaline -

1 ml 0.1% solution. In case of failure of this measure - tracheostomy

1. Gastric lavage, enterosorption, forced diuresis.

2. Treatment of bradycardia: atro-

Emergency care (1 - methods of active detoxification; 2 - antidote treatment; 3 - symptomatic therapy)

caused by stimulation of adrenoreactive systems. Biotransformation in the liver, excretion in the urine up to 24 hours. Toxic dose - more than 15 mg Caffeine and other xanthines (theophylline, theobromine, aminophylline, aminophylline). Psychotropic, neurotoxic (convulsive) action. The lethal dose is -20 g with large individual differences, the lethal concentration in the blood is more than 100 mg / l. Rapidly absorbed in the gastrointestinal tract, demethylated in the body, excreted in the urine as metabolites, 10% unchanged

Lithium - lithium carbonate. Psychotropic, neurotoxic, cardiotoxic action Lethal dose - 20 g. Toxic concentration in blood - 13.9 mg/l, lethal - 34.7 mg/l. Absorbed in the gastrointestinal tract, distributed evenly in the body in the intracellular and extracellular fluid. 40% is excreted in the urine, a small part - through the intestines

Mercury ointment: gray (contains 30% metallic mercury), white (10% mercury amide chloride), yellow (2% yellow mercury oxide)

development of severe sinus bradycardia (pulse up to 15-

20 beats / min), a sharp decrease in blood pressure (cardiogenic collapse);

Tinnitus, dizziness, nausea, vomiting, fever, palpitations. Possible pronounced psychomotor agitation, CLONIC-tonic convulsions. In the future, depression of the nervous system may develop up to a soporous state, severe tachycardia (sometimes paroxysmal, accompanied by arterial hypotension), and cardiac arrhythmias. With an overdose of drugs, especially when administered intravenously, an attack of CLONIC-tonic convulsions and a drop in blood pressure are possible. orthostatic collapse

Nausea, vomiting, abdominal pain, diarrhea, muscle weakness, limb tremor, adynamia, ataxia, drowsiness, constipation, coma. Heart rhythm disturbances, bradyarrhythmia, lowering of arterial pressure, acute cardiovascular insufficiency (collapse). On the 3rd-4th day - manifestations of toxic nephropathy. Characteristically undulating course of intoxication „„

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Poisoning develops when ointments are rubbed into the skin, especially into the hairy parts of the body and if there are excoriations, abrasions on the skin, or during prolonged exposure (more than 2 hours). For 1 -

On the 2nd day, signs of dermatitis appear and body temperature rises, which may also be a manifestation of hypersensitivity to mercury preparations. On the 3-5th day, symptoms of toxic nepin develop 0.1% -1-2 ml subcutaneously repeatedly

3. Strict bed rest, cardiovascular drugs

1. Gastric lavage through a probe, saline laxative. Forced diuresis. In severe cases - detoxification hemosorption.

3. Aminazin - 2 ml of a 2.5% solution intramuscularly. In severe cases, intramuscular administration of a lytic mixture: chlorpromazine - 1 ml of a 2.5% solution, promedol - 1 ml of a 1% solution, diprazine (pipolfen) - 2 ml

2.5% solution For convulsions - diazepam - 2 ml of a 2.5% solution intravenously. For relief of paroxysmal tachycardia - 10% solution of novocainamide 5 ml intravenously slowly

1. Gastric lavage through a probe. Forced diuresis.

In severe cases, early hemodialysis.

2. In a vein - sodium bicarbonate - 1500-2000 ml of a 4% solution, sodium chloride - 20-30 ml of a 10% solution after 6-8 hours for 1-2 days.

3. With a decrease in blood pressure - dopamine 40 mg in a 5% glucose solution intravenously drip until a clinical effect is obtained. Vitamins of group B, ATP - 2 ml of a 1% solution intramuscularly 2-3 times a day. Treatment of toxic nephropathy

1. Forced diuresis. Early hemodialysis with toxic concentration of mercury in the blood and severe symptoms of intoxication.

2. Unitiol - 5% solution according to

10 ml intramuscularly repeatedly.

3. Treatment of toxic nephropathy - in a hospital setting. On the affected areas of the skin - ointment bandages with hydrocortisone, anestezin. Treatment of stomatitis

Emergency care (1 - methods of active detoxification; 2 - antidote treatment; 3 - symptomatic therapy)

Copper and its compounds (copper sulfate). Pesticides containing copper: Bordeaux liquid (a mixture of copper sulphate and lime), Burgundy liquid (a mixture of copper sulfate and sodium carbonate), cupronapht (compound of copper sulphate with a solution of mylonaphth), etc. Local cauterizing, hemotoxic (hemolytic), nephrotoxic , hepatotoxic effect. The lethal dose of copper sulphate is 30-50 ml. The toxic concentration of copper in the blood is 5.4 mg/l. About 1/4 of the oral dose is absorbed from the gastrointestinal tract and binds to plasma proteins. Most of it is deposited in the liver. Excretion with bile, feces, urine

Morphine and other narcotic analgesics of the opium group: opium, pantopon, heroin, dionine, codeine, tekodin, phenadone. Preparations containing substances of the opium group (antitussive and gastric drops and tablets). Psychotropic (narcotic), neurotoxic effect. The lethal dose for oral morphine is

0.5-1 g, with intravenous administration - 0.2 g. The lethal concentration in the blood is 0.1-4 mg / l. All drugs are especially highly toxic for dephropathy, acute renal failure and at the same time manifestations of stomatitis, gingivitis, enlargement of regional lymph nodes, by 5-

6th day - enterocolitis When copper sulphate is ingested, nausea, vomiting, abdominal pain, frequent stools, weakness, dizziness, headache, tachycardia, exotoxic shock develop. With severe hemolysis (hemoglobin in the urine) - acute renal failure (anuria, uremia). Toxic hepatopathy. Hemolytic jaundice, anemia. If during welding of non-ferrous metals fine dust of copper (zinc and chromium) enters the upper respiratory tract, the phenomena of acute foundry fever develop: chills, dry cough, headache, weakness, shortness of breath, persistent fever. Possible allergic reaction (red skin rash, itching)

When toxic doses of drugs are taken orally or parenterally, a coma develops, which is characterized by a significant constriction of the pupils with a weakening reaction to light, skin flushing, muscle hypertonicity, and sometimes clonic-tonic convulsions.

In severe cases, respiratory failure and the development of asphyxia are often observed - a sharp cyanosis of the mucous membranes, pulmonary edema, dilated pupils, bradycardia, collapse, hypothermia. In severe poisoning with codeine, respiratory disorders are possible with the patient's consciousness preserved, as well as a significant decrease in blood pressure.

1. Gastric lavage through a probe. early hemodialysis. Forced diuresis.

2. Unitiol - 10 ml of a 5% solution, then 5 ml every 3 hours intramuscularly for 2-

3 days Sodium thiosulfate -

100 ml of 30% solution intravenously.

3. Morphine - 1 ml of 1% solution, atropine - 1 ml of 0.1% solution subcutaneously. With frequent vomiting - chlorpromazine - 1 ml of a 2.5% solution intramuscularly. Glucosone-vocaine mixture (glucose 5% - 500 ml, novocaine

2% - 50 ml intravenously). Antibiotics. Vitamin therapy. With hemoglobinuria - sodium bicarbonate - 1000 ml of a 4% solution intravenously. Treatment of acute renal failure and toxic hepatopathy - in a hospital setting. With foundry fever - acetylsalicylic acid - 1 g, codeine - 0.015 g orally. With an allergic rash - diphenhydramine -

1 ml 1% solution subcutaneously, calcium gluconate - 10 ml 10% solution intravenously

1. Repeated gastric lavage (even with parenteral administration of morphine), activated charcoal orally, saline laxative. Forced diuresis with alkalization of the blood. Detoxification hemosorption.

2. Introduction of 3-4 ml of 0.4% naloxone solution or 3-5 ml

0.5% nalorphine solution intravenously.

3. Subcutaneously atropine - 1-2 ml

0.1% solution, caffeine - 2 ml of 10% solution, cordiamine -

2 ml. Vitamin B | - 3 ml of 5% solution intravenously repeatedly. Oxygen inhalation, artificial respiration. Body warming

children of younger age. Rapidly absorbed from the gastrointestinal tract and when administered parenterally, detoxification in the liver by conjugation with glucuronic acid (90%), 75% excreted in the urine on the first day in the form of conjugates

Arsenic and its compounds. Nephrotoxic, hepatotoxic, enterotoxic, neurotoxic effects. The most toxic compounds are trivalent arsenic. The lethal dose of arsenic when taken orally is 0.1-0.2 g. The toxic concentration in the blood is 1 mg / l, the lethal one is 15 mg / l. Slowly absorbed from the intestine and when administered parenterally. Deposited in the liver, kidneys, spleen, wall of the small intestine, lungs. With the use of inorganic compounds, arsenic appears in the urine after 2-8 hours, excreted in the urine up to 10 days Organic compounds are excreted in the urine and feces within 24 hours

Naphthalene. Local irritant, hemotoxic

chemical (hemolytic) action. The lethal dose for adults when taken orally is about 10 g, for children - 2 g. Poisoning is possible by inhalation of vapors or dust, penetration through the skin,

When ingested, the gastrointestinal form of poisoning is more often observed. Metallic taste in the mouth, vomiting, severe abdominal pain. The vomit is greenish in color. Loose stools resembling rice water. Severe dehydration of the body, accompanied by chlorpenic convulsions. Hemoglobinuria as a result of hemolysis, jaundice, hemolytic anemia, acute liver and kidney failure. In the terminal phase - collapse, coma. A paralytic form is possible: stunning, convulsive state, convulsions, loss of consciousness, coma, respiratory paralysis, collapse. With inhalation poisoning with arsenic hydrogen, severe hemolysis, hemoglobinuria, cyanosis develop rapidly, on the 2nd-3rd day - hepatic-renal failure

Metallic mercury in the stomach and intestines is not absorbed. In open reservoirs, alkylmercury compounds are formed from metallic mercury, and when fish from such reservoirs are eaten, severe poisoning occurs. Through intact skin, 2-5% is absorbed. In the blood, mercury partially binds to proteins, most of it is deposited (especially lipid-soluble organic compounds) in the brain, liver, and kidneys. In the deposition organs, organic compounds gradually turn into inorganic ones. Mercury is excreted by the kidneys and gastrointestinal tract, organic compounds are much slower than inorganic ones.

sodium salicylate

Hydrogen sulfide. neurotoxic, hypoxic,

local irritant effect Lethal concentration in the air - 1.2 mg/l Hydrocyanic acid and other cyanides. Absorbed rapidly from the gastrointestinal tract, through the respiratory tract, skin. Characterized by rapid development, symptoms of damage to the gastrointestinal tract (frequent loose stools) and the central nervous system (drowsiness, periods of excitation) are present. On the 3-4th day - a manifestation of toxic nephropathy. Clinic of poisoning - see Sublimate, Granosan, Mercury ointment

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Runny nose, cough, pain in the eyes, blepharospasm, headache, nausea, vomiting, agitation.

In severe cases - coma, convulsions, toxic pulmonary edema

1. Amyl nitrite inhalation (2-3 ampoules). Gastric lavage through a probe, preferably with a 0.1% solution of potassium permanganate. activated charcoal inside

2. Sodium nitrite - 10 ml of 1% solution intravenously slowly

Emergency care (1 - methods of active detoxification; 2 - antidote treatment;

3 - symptomatic therapy)

volumes of intoxication. Neurotoxic effect, blocking of cellular cytochrome oxidase (tissue hypoxia). The lethal dose of hydrocyanic acid is 50-100 mg, sodium cyanide - 150 mg, potassium cyanide - 200 mg. Lethal concentration in blood - 5 mg/l

Turpentine. Local irritant, psychotropic, nephrotoxic effect. The lethal dose for adults is 100-150 ml, for children - 15 ml. Rapidly absorbed from the intestines, through the respiratory tract, skin. Conjugated with glucuronic acid in the body, excreted in the urine

Methyl alcohol (methanol, wood alcohol). Psychotropic (narcotic), neurotoxic (optic nerve dystrophy), nephrotoxic effect. The lethal dose is about 100 ml (without prior intake of ethanol). Toxic concentration in the blood - 200 mg / l, lethal - 800 mg / l. Rapidly absorbed in the stomach and intestines. It undergoes slow oxidation with the formation of toxic metabolites, formaldehyde and formic acid. Part is excreted unchanged through the lungs (up to 75%) within 48 hours, the rest is excreted in the urine

tye membranes are cyanotic. At

ingestion of lethal doses appear clonic-tonic convulsions, severe cyanosis, acute cardiovascular failure and respiratory arrest. Death can occur within a few minutes (the so-called fulminant, or apoplexy, form of poisoning)

Upon ingestion, there is a sharp pain in the esophagus and in the abdomen, vomiting with blood, loose stools, severe weakness, dizziness. Possible psychomotor agitation, delirium, convulsions, loss of consciousness, coma with respiratory failure by the type of mechanical asphyxia. Later, bronchopneumonia, nephropathy, and renal failure may appear. With inhalation - tracheobronchitis, conjunctivitis, toxic pneumonia and edema may develop

Intoxication is mild, nausea, vomiting. Flashing "flies" before the eyes. On the 2-3rd day, blurred vision and blindness appear. Pain in the legs, head, increased thirst The skin and mucous membranes are dry, hyperemic, with a bluish tint. The tongue is covered with a gray coating, the pupils are dilated, the weakening of their reaction to light. Tachycardia with subsequent slowing and heart rhythm disturbances. Severe metabolic acidosis. Arterial pressure is first elevated, then falls. Consciousness is confused, psychomotor agitation, convulsions, coma are possible. Hypertonicity of the muscles of the extremities, stiff neck. Toxic shock, respiratory paralysis

after 10 minutes 2-3 times. Sodium thiosulfate - 50 ml of 30% solution and methylene blue -

50 ml of 1% solution intravenously.

3. Glucose - 20-40 ml of 40% solution intravenously repeatedly. Oxygen therapy. Vitamin B] 2 - up to 1000 mcg per day intramuscularly and ascorbic acid - 20 ml of a 5% solution intravenously. Cardiovascular agents. Resuscitation measures

1. Gastric lavage Forced diuresis.

3 With pain in the abdomen - subcutaneously promedol - 1 ml of a 1% solution, atropine 1 ml of a 0.1% solution, papaverine - 1 ml of a 2% solution. Intravenous - glucosone-vocaine mixture (glucose 5% - 500 ml, novocaine

2% - 50 ml) With excitement and convulsions - diazepam - 4 ml

2.5% solution intramuscularly. Cardiovascular agents. Vitamins B|2 - 400 mcg, B| -

5 ml of a 5% solution intramuscularly (do not inject simultaneously). Treatment of toxic shock and nephropathy

1. Gastric lavage, saline laxative. Forced diuresis with alkalization of the blood. Early hemodialysis

2. Ethyl alcohol 30% -

100 ml orally, then every 2 hours, 50 ml 4-5 times In a coma - intravenous drip of ethyl alcohol in the form

5% solution at the rate of 1 g / kg per day

3. Prednisolone - 25-30 mg

intravenously. Vitamin B| -

5 ml of 5% solution and ascorbic acid - 20 ml of 5% solution intravenously. Glucose -

300 ml of 5% solution and novocaine - 30 ml of 2% solution intravenously. ATP - 2-3 ml

1% solution intramuscularly repeatedly. Treatment of toxic shock. Lumbar puncture for cerebral edema

Emergency care (1 - methods of active detoxification; 2 - antidote treatment;

3 - symptomatic therapy)

Ethyl alcohol (ethanol, alcoholic beverages). Psychotropic (narcotic) action. The lethal dose is about 300 ml (95%), in those accustomed to alcohol it is much higher. Toxic concentration in the blood - 1.5 g / l, lethal - 3.5 g / l. Quickly (40-90 min) absorbed in the stomach (20%) and small intestine (80%). Oxidized to form acetaldehyde and acetic acid. It is excreted through the lungs and in the urine within 7-12 hours.

Corrosive sublimate. Local cauterizing, enterotoxic, nephrotoxic

action. Lethal dose - 0.5 g

Sulfonamides (sulfadimezin, norsulfazol, sulfadimethoxine, etc.).

Nephrotoxic, hemotoxic effect. The rate of absorption in the gastrointestinal tract for various drugs in this group is not the same Excretion in the urine in free and acetylated form

When toxic doses are ingested, coma quickly develops after the well-known symptoms of intoxication. Cold clammy skin, flushing of the face, decrease in body temperature, vomiting, involuntary excretion of urine and feces. The pupils are constricted, and with an increase in respiratory distress, they are dilated. horizontal nystagmus. Respiration is slow, the pulse is frequent, weak. Sometimes - convulsions, aspiration of vomit, laryngospasm. It is possible to stop breathing as a result of mechanical asphyxia, followed by a drop in cardiovascular activity ....

Specific therapy is the use of drugs that act directly on the influenza virus. Drugs with direct antiviral action include neuraminidase inhibitors: oseltamivir, zanamivir, as well as drugs from the adamantane group, which act at an early stage of specific reproduction after the virus enters the cell and before the initial transcription of RNA. The pharmacological efficacy of these drugs is provided by the inhibition of virus reproduction in the initial stage of the infectious process. That is why it is so important to make a correct diagnosis of flu as soon as possible and start competent specific treatment. In the case of early initiation of therapy, these drugs can reduce the duration of the disease, the severity and duration of individual symptoms. They also greatly reduce the risk of complications.

The most effective appointment of specific antiviral agents in the first two days from the onset of the disease!

Neuraminidase inhibitors: oseltamivir, zanamivir

One of the most promising areas of treatment for the most common infectious disease on Earth - influenza (recall that it accounts for almost 95% of all infections on the planet) today is the use of neuraminidase inhibitors: oseltamivir and zanamivir.

Adamantanes (M2 channel inhibitors): amantadine and rimantadine

The M2 channel inhibitors, amantadine and rimantadine, were discovered in the 1960s. Both drugs are active against type A influenza viruses and not active against type B viruses.

Arbidol

In Russia, the original domestic drug Arbidol has become widespread, demonstrating antiviral activity in numerous preclinical studies performed in leading research centers in Russia, the USA, Great Britain, Australia, France, and China.

Interferon preparations

Interferons are used to treat and prevent various viral infections, including influenza and other acute respiratory viral infections.

How to treat a viral infection: what to choose for influenza therapy?

Respiratory viral infections (including influenza) often cling to us in the spring (especially early), and, of course, in this case the question arises, how to treat a viral infection?

Influenza virus: volatile and insidious

Probably every schoolchild, not to mention adults, is familiar with such concepts as ARVI and influenza firsthand. Almost every year someone in our neighborhood gets the flu. Unless, of course, there is an epidemic. During epidemics, almost everyone gets sick. What do epidemiologists predict for the near future?