Chemical poisoning does not appear immediately. Symptoms and principles of first aid for chemical poisoning. Symptoms of chemical poisoning depending on the type

Chemical poisoning can be provoked by pesticides, hydrocyanic acid salts, solvents, acids, cleaning products, medications and other substances containing active chemical agents. Effective help with symptoms of poisoning chemicals depends on the route of entry, type of poison, dose, age and health of the person affected. To save life and health, it is important to competently provide first aid to the victim, take him to the hospital.

Pesticides

Pesticides are chemicals used to kill pests. Types of pesticides: repellents, insecticides, herbicides, growth regulators; attractants. Contain salts heavy metals(copper, mercury), organochlorine (dust), organophosphorus, urea-containing substances.

at home or agriculture Pesticide poisoning occurs when life safety rules are not followed. Pesticide poisoning occurs when poisons penetrate the skin, with food products, airborne, contact-household way.

Pesticide poisoning is characterized by a clinical picture that depends on the main toxin that is part of the pesticide:

First aid

If intoxication with pesticides occurs, you need:

to ensure the cessation of the entry of poisons into the body;
give protein, starch or Almagel a drink (they have enveloping properties and reduce absorption);
as a sorbent, give activated carbon to drink (one tablet per kilogram of weight);
wash eyes with 2% soda solution, wash skin with soap and water;
induce vomiting if toxic substances are ingested.

cyanide poisoning

Types of cyanides: cyanic acid, potassium cyanide, sodium cyanide - salts of cyanic acid. Rosaceae seeds (plums, apricots, almonds) contain amygdalin, which decomposes to hydrocyanic acid.

The ways of getting into the body are household (potassium cyanide salts are part of artistic paints) and industrial (cyanides are used in electroplating, pesticides, plastics).
At quick form Intoxication with hydrocyanic acid literally in a few seconds convulsions occur, pressure rises and falls, breathing stops, death occurs. The slow form of hydrocyanic acid poisoning lasts up to several hours. Symptoms: smell and taste of bitter almonds, vomiting, headache, rapid breathing, chest pain, depressed consciousness.
With severe intoxication with a cyanide salt or cyanic acid, convulsions appear, cardiovascular failure, paralysis, fatal outcome.

Help with intoxication with salt - potassium cyanide and hydrocyanic acid should be emergency:

remove the victim to the air;
remove clothes from the victim, put them in a bag for further disposal (if possible, use gloves or tongs);
wash the victim with soap and water, rinse eyes well clean water;
wash the stomach with 2% soda solution;
give warm tea with sugar to drink (glucose blocks the toxic effect of hydrocyanic acid); drip amyl nitrite onto a cotton swab (from the first-aid kit of the enterprise to provide first aid in case of poisoning with potassium cyanide and hydrocyanic acid), give a sniff every two minutes;
if necessary, perform artificial respiration.

Solvent poisoning

Solvents are chemical organic substances. The main solvents include acetone, gasoline, ether, alcohols, chloro-, dichloroethane, solvent.

Penetrate into the lungs in the form of vapors, through the skin are absorbed into the blood. Solvent poisoning can cause narcotic symptoms.

Symptoms of intoxication: irritation of the mucous membranes, accompanied by coughing and sneezing, headache and dizziness, salivation, abdominal pain, vomiting, fainting, convulsions. Possible damage to the main organs: liver, kidneys, cardiovascular, nervous, respiratory systems.

First aid

remove the injured person to the air;
wash the body, rinse the eyes with running water;
take activated charcoal tablets.

You can not drink hot sweet drinks, milk, vegetable oil - these products increase the absorption of poisons! Do not call with oil products!

If severe poisoning is suspected, you should consult a doctor in order to avoid the development of complicated bronchitis, pneumonia, hepatitis, and nephritis.

Arsenic poisoning

Arsenic poisoning can occur by negligence or by suicide.

Penetration into the body occurs when using products containing arsenic (part of food preservatives), when using pesticides, antifungal drugs with arsenic.
Arsenic is used in factories for the production of glass, electronic devices, the leather industry, and chemical industries.

Arsenic poisoning is characterized by a garlicky smell on the breath, dehydration, stools resembling rice water. When arsenic vapor enters the respiratory tract, rapid death can occur. In case of arsenic poisoning, all organ systems are affected: conduction in the heart muscle is disturbed, pulmonary edema and signs of respiratory failure develop, jaundice, erosion of the esophagus, bleeding, kidneys are affected.

It is impossible to get poisoned with an arsenic preparation during dental treatment if the toxic material is removed on time.

First aid is standard. You need to do a gastric lavage. To wash the stomach, you need to prepare two liters of water with salt (two teaspoons per liter of water). Remove poison from the surface of the skin by washing with soap. Activated charcoal does not need to be drunk, it practically does not help the absorption of the poison.

Sulfur poisoning

Types of sulfur compounds: sulfurous anhydrite (part of smog), hydrogen sulfide (formed in sewers), carbon disulfide of chemical enterprises, sulfuric acids and salts.
Penetrate through the respiratory tract, skin, digestive system. Pure sulfur poisoning is rare, most often poisoning with sulfur compounds is observed - a salt of sulfuric acid, oxides, sulfurous acid or sulfuric acid.

Symptoms of hydrogen sulfide poisoning: pain in the eyes, shortness of breath, pulmonary edema, death may develop.

Carbon disulfide has a neurotoxic and psychotropic effect: flushing, burning, headache, nausea, garlic smell, convulsions, loss of consciousness, coma, paralysis. May be fatal.

Symptoms of hydrogen sulfide poisoning: pain in the eyes, shortness of breath, symptoms of bronchitis, pulmonary edema, death may develop.

Symptoms of sulfur dioxide poisoning: cough, wheezing in the lungs, hemoptysis, edema.

First aid:

Remove the injured person from the poisonous area.
Wash exposed skin with soap and water.
You can drop amyl nitrite on a cotton wool and let the victim breathe.
Give a sniff of ammonia.
In case of acid burns, it is necessary to wash the damaged area of the body with clean water and rinse with a weak soda solution.
In case of acid burns, the eyes should also be rinsed with plenty of running water, then rinsed with a 2% soda solution.

Gas poisoning

Poisoning occurs by inhalation of air with a mixture of butane and propane.

Symptoms of poisoning: headache, agitation, nausea, constriction of the pupils, slow pulse, salivation, decreased pressure

First aid:

Remove the victim from the room, create an influx of fresh air.
Give the patient a drink to remove toxins, a sorbent.
If the heart and breathing stop, do heart massage and artificial respiration.

Health care

Help is directed to:

removal of poisons from the body;
the introduction of antidotes;
maintaining the health of organs and organ systems;
relieve symptoms of hypoxia;
infusion, symptomatic therapy, oxygen therapy, hemodialysis.

Each type of poisoning has its own developed complex of medical treatment.

Prevention of poisoning

Compliance with safety regulations.
Study of instructions for use and precautions when working with toxic substances.

Folk remedies and herbs for the treatment of poisoning

To remove lead salts and heavy metals from the body, you can prepare an infusion of horsetail (1:20), drink half a glass 3-4 times a day.
Toxins are actively removed by infusion of knotweed (add a spoonful of grass to two glasses of water). Drink the infusion in the third part of a glass 2-3 times a day.
Chronic mercury poisoning is treated with an infusion of 3 tablespoons of green walnuts, 5 tablespoons of horsetail. You need to take 2 dessert spoons of the collection, pour a liter of boiling water, let it brew and take 100 ml 6 times a day.
In case of poisoning carbon monoxide recommended infusion of 100 g of cranberries and 200 g of cranberries. Steam in 300 ml of boiling water, insist, take 50 ml 6 times a day.
In a glass of boiling water, insist 20 g of elecampane root for 20 minutes. Drink with liver intoxication in a tablespoon 4 times a day.
If you burn your throat with chemicals, you need to drink oil solution St. John's wort: take 2 cups of olive oil per glass of flowers and leave for about a month.
Antitoxic decoction. Insist 10 g of nettle in a glass of boiling water, drink 3 times a day for a tablespoon.

Poisoning- a set of adverse effects caused by hit toxic substance in the gastrointestinal tract and respiratory tract, or by contact with the skin, eyes or mucous membranes (polystyrene, vagina, etc.).

What provokes / Causes of Chemical poisoning:

Poisons include certain drugs, household chemicals, solvents, pesticides, and other chemicals.

Symptoms of chemical poisoning:

Symptoms of poisoning depend on the type and amount of poison ingested, and individual characteristics the victim. Some poisons with low toxicity cause certain disorders only when long-term exposure or re-entry into the body in large numbers. Other substances are so poisonous that even a single drop of such a poison on the skin can lead to dire consequences. The toxicity of a substance in each case also depends on the genetic characteristics of a person. Some normally non-toxic substances are toxic to people with a certain genotype (set of genes).

The dose of a substance that causes symptoms of poisoning is also very dependent on age. For example, at small child ingesting more paracetamol is more likely to cause symptoms of poisoning than the same dose in an adult. For an elderly person sedative from the group of benzodiazepines (seduxen, relanium, phenazepam) can be toxic in doses that do not cause any disturbance in a middle-aged person.

Symptoms of poisoning may be mild but unpleasant, such as itching, dry mouth, blurred vision, pain, or may be life-threatening, such as confusion, coma, impaired heart rate, shortness of breath and marked agitation. Some poisons begin to act after a few seconds, while others take several hours or even days after they enter the body.

There are poisons that do not cause obvious symptoms until there is irreversible damage to the function of the vital important organs especially the liver or kidneys. Thus the symptoms of poisoning are as innumerable as the number of poisons.

Diagnosis of chemical poisoning:

Optimal management of patients with poisoning requires setting correct diagnosis. Although the toxic effects of some chemicals are very characteristics, most of the syndromes observed with poisoning may be due to other diseases.

Poisoning is usually included in differential diagnosis coma, seizures, acute psychosis, acute liver or kidney failure and bone marrow depression. Although this should be done, the possibility of poisoning can be disregarded when the patient's main manifestations are mild mental or neurological impairment, abdominal pain, bleeding, fever, hypotension, pulmonary congestion, or skin rash. In addition, the patient may not be aware of the effect of the poison on him, as is the case with chronic, latent poisoning, or after an attempted suicide or abortion, the patient will also not be inclined to agree with such a diagnosis. Physicians should always be aware of the various manifestations of poisoning and maintain a high degree of alertness to them.

In all cases of poisoning, an attempt should be made to identify the toxic agent. It is obvious that without such identification it is impossible to carry out specific therapy with antidotes. In cases of murder, suicide, or criminal abortion, the identification of poison can have legal implications. Where poisoning is the result of industrial exposure or therapeutic error, precise knowledge of the active agents is necessary to prevent similar occurrences in the future.

For acute accidental poisoning active substance may be known to the patient. In many other cases, information can be obtained from relatives or acquaintances, by examining containers located at the site of poisoning, or by interviewing the patient's doctor or pharmacist. Often similar actions allow you to establish only the trade name of the product, which does not allow you to know its chemical composition. The bibliography at the end of this chapter lists a number of books that list the active constituents of substances used in households, agriculture, patent medicines, and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. Less urgency medical measures in these cases, it usually allows for the necessary careful study of the patient's habits and the state of the environment.

Some poisons can cause the development of characteristic clinical signs sufficient to make strong assumptions about the exact diagnosis. With a thorough examination of the patient, a characteristic smell of cyanide can be detected; cherry staining of the skin and mucous membranes, revealing the presence of carboxyhemoglobin; pupillary constriction, drooling and hyperactivity of the gastrointestinal tract caused by insecticides containing cholinesterase inhibitors; lead border and paralysis of the extensor muscles, characteristic of chronic lead poisoning. Unfortunately, these typical signs are not always present, and in case of chemical poisoning, their presence is rather an exception.

Chemical analysis of body fluids provides the most correct definition substance that caused poisoning. Some common poisons, such as acetylsalicylic acid (aspirin) and barbiturates, can be detected and even quantified using relatively simple methods. laboratory research. Other poisons require more complex toxicological studies such as gas or liquid chromatography to be detected. high resolution which are carried out only in specialized laboratories. In addition, the results of toxicological studies are rarely available in a timely manner to decide on initial treatment in acute poisoning. However, samples of vomit, aspirated stomach contents, blood, urine, and feces should be retained for toxicology testing if diagnostic or legal issues arise. Chemical analysis of body fluids or tissues is particularly important in the diagnosis and assessment of severity. chronic poisoning. Ultimately, the results of such an analysis are useful for evaluating the long-term results of some types of therapy.

Treatment for chemical poisoning:

For proper treatment A patient with poisoning needs to know both the basic principles of managing such patients and the details of therapy for specific poisonings. The treatment process includes:

prevention of further absorption of the poison;
removal of the absorbed poison from the body;
symptomatic supportive therapy or symptomatic treatment for circulatory disorders, respiratory disorders, neurological disorders and impaired renal function;
introduction of systemic antidotes.

The first three steps apply to most types of poisoning. The fourth step is most often used only when the toxic agent is known and a specific antidote is available. Sometimes, however, when a patient is highly suspected of having an opiate overdose, they are given naloxone. It should be recognized that there are no specific antidotes for most poisons, and it is not necessary to know which toxic agent caused the poisoning in order to provide the necessary maintenance therapy. Thus, although the physician should always try to identify the active poison, these attempts should not delay the implementation of vital therapeutic measures. .

Prevention of absorption of ingested poisons. If an appreciable amount of poison has been swallowed, attempts should be made to minimize its absorption from the gastrointestinal tract. The success of such attempts depends on the time elapsed since the poison was ingested and on the site and rate of absorption.

Evacuation of stomach contents

Always, if there are no specific contraindications, you should try to empty the stomach. These attempts can be very successful if made soon after the poison has been ingested. Significant amounts of poison can still be expelled from the stomach a few hours after ingestion, as gastric emptying may be delayed as a result of gastric atony or pylorospasm. This occurs with phenothiazine poisoning, antihistamines and tricyclic antidepressants.

After swallowing many poisons, vomiting occurs spontaneously. In a smaller number of cases, it can be induced at home by mechanical stimulation of the back of the throat. Vomiting effect of ipecac syrup (the concentration should not exceed more than 14 times the concentration liquid extract), given in a dose of 15 - 30 ml, is more effective and safe even at home. Its action begins an average of 20 minutes after ingestion and depends in part on absorption in gastrointestinal tract, so should be avoided simultaneous reception activated carbon, which is an adsorbent. A second dose of ipecac syrup should be given to the patient if he does not vomit 20 minutes after taking the first dose (after taking two doses, vomiting will develop in 90-95% of patients). If there is no scrap of ipecac syrup, every effort should be made to find it, even if this requires taking the patient to the hospital. Apomorphine administered intramuscularly at a dose of 0.06 mg/kg acts within 5 minutes, but may cause prolonged vomiting. At intravenous administration at a dose of 0.01 mg/kg, apomorphine induces vomiting almost immediately, with no subsequent effect on the central nervous system. Sometimes it is not possible to induce vomiting and valuable time should not be wasted waiting. Attempts to induce vomiting should not be made on victims who are in convulsive state, in patients with severe depression of the central nervous system or (due to the risk of perforation of the stomach or esophagus, or due to aspiration of vomit into the trachea) in persons who have ingested a strong caustic chemical or small quantities(less than 100 ml) liquid hydrocarbons that are strong lung irritants (eg kerosene, polish).

Compared to vomiting, gastric lavage is more preferable and acts immediately, but usually it does not contribute more effective removal poison from the stomach than vomiting. It can be performed in patients who are unconscious, the evacuation of the contents of the stomach reduces the risk of aspiration of vomit. Its performance, however, is contraindicated after ingestion of strong corrosive substances, because of the danger of perforation of damaged tissues. At correct execution gastric lavage carries a small risk of aspiration of stomach contents into the lungs. The patient should lie on his stomach with his head and shoulders down. Using a mouth expander, a gastric tube is introduced into the stomach, the diameter of which is sufficient to pass solid particles (30 gauge). If the functions of the central nervous system are depressed, if the insertion of the probe causes vomiting, or if a substance that is an irritant to the lungs has been swallowed, it is reasonable to introduce a cuffed endotracheal tube into the trachea before performing gastric lavage. The contents of the stomach are aspirated with a large syringe, and with it most of the poison is removed from the body. After that, 200 ml (in children less) of warm water or liquid solution is injected into the stomach and aspirated until the aspirated liquid becomes clear.

Interference with absorption in the gastrointestinal tract.

Since neither vomiting nor gastric lavage completely empties the stomach, attempts should be made to reduce absorption by administering substances that bind poisons that have entered the body. Many poisons are adsorbed by powdered activated carbon. High quality activated carbon can adsorb 50% by weight of many common poisons. Liquid activated charcoal (20-50 g in 100 * 200 ml) should be administered after gastric emptying.

Adsorption by activated carbon is a reversible process and the efficiency of adsorption of many poisons varies depending on the pH value. Acidic substances are adsorbed better by acid solutions and therefore can be released into small intestine. It is desirable that activated charcoal with adsorbed poison pass through the intestines as quickly as possible. This will also reduce intestinal absorption of any unabsorbed poison that has passed through the pylorus. In patients with good renal and cardiac function, this is best achieved by oral or intramuscular injection osmotic laxatives such as magnesium or sodium sulfate (10-30 g in solution at a concentration of 10% or less).

Prevention of absorption of poison from other organs and systems. Most locally applied poisons can be removed from the body by copious washings with water. In certain cases, weak acids or alkalis, or alcohol in combination with soap, are more effective, but rapid and abundant washing with water must be carried out until these solutions are available to doctors. Chemical antidotes are dangerous because the heat generated during chemical reaction may cause tissue damage.

The systemic distribution of injected poisons can be slowed down by applying cold compress or ice or apply a tourniquet proximal to the injection site.

After inhalation of toxic gases, vapors or dusts, remove the victim to clean air and maintain adequate ventilation. The patient cannot move, he should wear a protective mask.

Excretion of absorbed poison from the body. In contrast to preventing or slowing down absorption, measures that speed up the excretion of a toxic agent and the body rarely have a large effect on the peak concentration of the poison in the body. However, they can significantly reduce the time during which the concentration of many poisons remains above a certain level, and thereby reduce the risk of complications and tackle the life of the patient. When assessing the need to perform such measures, it is necessary to take into account the clinical condition of the patient, the properties and pathways of the metabolism of the poison and the amount of absorbed poison according to the anamnesis data and the results of determining its concentration in the blood. The introduction of some poisons can be accelerated by various methods; the choice of method depends on the condition of the patient, the amount of poison in the body and the availability of experienced personnel and equipment.

Bile excretion

Certain organic acids and active drugs are secreted into the bile in the opposite direction of the large concentration gradient. This process takes time and cannot be accelerated. However, intestinal absorption of substances already secreted into bile, such as glutethimide, can be reduced by the administration of activated charcoal every 6 hours. Cholestyramine (16 g per day) significantly accelerates its excretion (half-life from the blood is 80 days).

Urinary excretion

The acceleration of renal excretion is justified in cases of poisoning much a large number poisons. Renal excretion of toxic substances depends on glomerular filtration, active tubular secretion and passive tubular resorption. The first two of these processes can be protected by maintaining adequate circulation and kidney function, but in practical terms, they cannot be accelerated. On the other hand, passive tubular resorption of many poisons plays an important role in increasing their duration of action and can often be reduced by readily available methods. In case of poisoning with drugs such as drugs salicylic acid and long-acting barbiturates, increased diuresis induced by administration of large volumes of electrolyte solutions in combination with intravenous furosemide has been shown to increase renal excretion.

Changing the pH of urine can also inhibit the passive reversible diffusion of some poisons and increase their renal clearance. The epithelium of the renal tubules is more permeable to uncharged particles than to ionized solutions. Weak organic acids and bases readily diffuse out of the tubular fluid in their non-ionized form, but are retained in the tubules if they are ionized. Acidic poisons are ionized only at a pH exceeding their pK. Alkalinization of urine sharply increases ionization in the tubular fluid of such organic acids like phenobarbital and salicylate. In contrast, the pKa of pentobarbital (8.1) and secobarbital (8.0) are so high that renal clearance does not increase appreciably with increasing urinary pH at physiological alkaline limits. Alkalinization of urine is achieved by infusion of sodium bicarbonate at a rate determined by the pH value of urine and blood. Severe systemic alkalosis or electrolyte disturbances should be avoided. The combination of induced diuresis with alkalinization of the urine can increase the renal clearance of some acidic poisons by a factor of 10 or more, and these measures have been found to be very effective in salicylates, phenobarbital, and 2,4-dichlorophenoxyacetic acid poisoning. Conversely, a decrease in pH below its usual values has been shown to increase the clearance of amphetamines, phencyclidines, fenfluramine, and quinine.

In conclusion, it should be noted that the renal excretion of certain poisons can be increased by highly specific methods. An example of this is the elimination of bromide from the body by the administration of chloride and chloruretics. These methods are discussed under the consideration of individual poisons.

Dialysis and hemosorption

Dialysis has been found to be effective in removing many substances from the body, including barbiturates, borate, chlorate, ethanol, glycols, methanol, salicylates, sulfonamides, theophylline, and thiocyanate. Theoretically, it should accelerate the elimination from the body of any dialyzable toxin that is not irreversibly bound to the tissues. Its effectiveness does not extend to large molecules, non-dialysable poisons, and is reduced to a large extent by binding toxic substance with proteins or its solubility in fats.

Peritoneal dialysis can be easily performed in any hospital and can be done for a long time. However, its implementation in order to remove poisons from the body is justified only if the patient has impaired renal function, it is impossible to carry out hemodialysis or hemosorption, or forced diuresis cannot be applied.

Hemodialysis is undeniably more effective in terms of excretion from the body large quantities dialysable poisons. For barbiturates, dialysis rates of 50–100 ml/min have been achieved, while the rate of excretion from the body is 2–10 times higher than with peritoneal dialysis or forced diuresis. With blood perfusion through activated charcoal or ion-exchange resin, even greater clearance rates of most poisons are achieved than with hemodialysis. Obviously, extracorporeal dialysis and hemosorption can be considered as the procedures of choice for rapid elimination poisons from the body of patients who have absorbed such amounts of poison that make their survival unlikely even if the best supportive therapy is provided. Since not every hospital has the necessary equipment and experienced staff for hemodialysis and hemosorption, consideration should be given to transferring such patients to a facility with such facilities.

Complex formation and chemical bonding. The excretion of certain poisons from the body is accelerated by chemical interaction. actions with other substances with subsequent excretion through the kidneys. These substances are considered systemic antidotes and are discussed under individual poisons.

supportive therapy. Most chemical poisonings are reversible, self-limiting painful conditions. Skillful supportive care can save the lives of many severely poisoned patients and keep their detoxifying and excretory mechanisms functioning until the poison concentration is reduced to safe levels. Symptomatic measures are especially important when the active poison belongs to the category of substances for which a specific antidote is unknown. Even when an antidote is available, vital signs should be prevented or controlled with appropriate supportive care.

A patient with poisoning may suffer from various physiological disorders. Most of these are not specific to chemical poisonings and the management of such patients is discussed elsewhere. This section briefly discusses only those aspects of maintenance therapy that are specifically relevant to the treatment of poisoning.

Depression of the central nervous system. Specific therapy aimed at combating the inhibitory effect of poisons on the central nervous system is usually neither necessary nor difficult. Most patients with poisoning come out of a coma, as from a long anesthesia. Careful care is needed during the unconscious period nurse and careful monitoring of the patient. If the oppression of centers located in medulla oblongata, occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using chemical means and mechanical procedures. The use of analeptics in the treatment of patients with poison-induced central nervous system depression has been largely abandoned. It is certain that these substances should never be used to awaken consciousness, and it is doubtful that their use to hasten the recovery of spontaneous breathing and active reflexes has ever been justified. In contrast, the drug antagonist naloxone, administered intravenously in adequate doses, usually reverses the central nervous system depression associated with drug overdose.

Seizures. Many poisons (eg, chlorinated hydrocarbons, insecticides, strychnine) cause seizures due to their specific stimulating effect. In patients with poisoning, convulsions may also occur due to hypoxia, hypoglycemia, cerebral edema, or metabolic disorders. In such cases, these violations should be corrected as far as possible. Regardless of the cause, seizures are often necessary application anticonvulsants. Intravenous diazepam, phenobarbital, or phenytoin are usually effective.

Cerebral edema. An increase in intracranial pressure due to cerebral edema is also a characteristic sign of the action of some poisons and a non-specific consequence of other chemical poisonings. For example, cerebral edema is observed in case of poisoning with lead, carbon monoxide and methanol. Symptomatic treatment consists in the use of adrenocorticosteroids and, when necessary, in intravenous administration hypertonic solutions mannitol or urea.

Hypotension. The causes of hypotension and shock in the poisoned patient are numerous and often there are several causes at the same time. Poisons can cause inhibition of vasomotor centers in the medulla, block autonomic ganglia or adrenergic receptors, directly inhibit the tone of smooth muscles of arteries or veins, reduce myocardial contractility or induce the appearance of cardiac arrhythmias. Less specific is when the poisoned patient is in shock due to tissue hypoxia, extensive tissue destruction by corrosives, loss of blood and fluid, or metabolic disorders. If possible, these violations should be corrected. If the central venous pressure is low, then the first therapeutic action should be to replenish the volume of fluid in the body. Vasoactive drugs are often useful and sometimes necessary in the treatment of a poisoned patient who develops hypotension, especially in shock due to central nervous system depression. As with shock due to other causes, the choice of the most appropriate drug requires an analysis of hemodynamic disturbances, which is carried out after measuring the value of blood pressure.

cardiac arrhythmias. Violations of the generation of an excitation wave or cardiac conduction in patients with poisoning occur as a result of the action of certain poisons on the electrical properties of the heart fibers or as a result of myocardial hypoxia or metabolic disorders in the myocardium. The latter need to be adjusted, and antiarrhythmic drugs are used according to indications, based on the nature of this arrhythmia.

Pulmonary edema. A patient with poisoning may develop pulmonary edema due to inhibition of myocardial contractility or damage to the alveoli by irritating gases or asphyxiated fluids. The latter type of edema is less treatable and may be accompanied by laryngeal edema. Therapeutic measures include aspiration of exudate, giving high concentrations of oxygen under positive pressure, the introduction of aerosols of surfactants, bronchodilators and adrenocorticosteroids.

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may operate simultaneously. Inadequate ventilation may result from central respiratory depression, muscle paralysis, or obstruction respiratory tract accumulated secrets, laryngeal edema or bronchospasm. Alveolar-capillary diffusion may be impaired in pulmonary edema. Anemia, methemoglobinemia, carboxyhemoglobinemia, or shock can impair oxygen transport. Inhibition of cellular oxidation may occur (eg, cyanides, fluoroacetate). For treatment, it is necessary to maintain adequate patency airways. The clinical situation and site of the obstruction may indicate frequent suctioning, insertion of an oropharyngeal airway or endotracheal tube, or tracheotomy. If, despite a normal airway, ventilation remains inadequate, as evidenced by clinical condition or measurement of minute volume or gas composition blood, it is imperative to carry out artificial ventilation with the help of appropriate mechanical means. In tissue hypoxia, the introduction is always indicated. high concentrations oxygen. In cases where there is severe depression of the central nervous system, the introduction of oxygen often leads to respiratory arrest and must be accompanied by artificial ventilation.

Acute renal failure. Renal failure with oliguria or anuria may develop in a patient with poisoning due to shock, dehydration, or electrolyte imbalance. In more specific cases, it may be due to the nephrotoxic effects of certain poisons (eg, mercury, phosphorus, carbon tetrachloride, bromate), many of which are concentrated and excreted by the kidneys. Kidney damage caused by poisons is usually reversible.

Electrolyte and water balance. Electrolyte and water imbalances are common signs of chemical poisoning. They may be due to vomiting, diarrhea, renal failure, or therapeutic measures such as bowel cleansing with laxatives, forced diuresis, or dialysis. These disorders can be corrected or prevented by appropriate therapy. Certain poisons are more specific, causing metabolic acidosis (eg, methanol, phenol, salicylate) or hypocalcemia (eg, fluoride compound, oxalate). These violations and all kinds specific treatment described in the sections on individual poisons.

Acute liver failure. The primary manifestation of some poisonings (eg, chlorinated hydrocarbons, phosphorus, hipofen, certain fungi) is acute liver failure.

Administration of systemic antidotes. Specific antidote therapy is possible only in case of poisoning with a small number of poisons. Some systemic antidotes are chemicals that exert their therapeutic effect by lowering the concentration of a toxic substance. This is achieved by combining an antidote with a specific poison (eg, ethylenediaminetetraacetate with lead, dimercaprol with mercury, reagents having sulfhydryl groups with a toxic metabolite of acetaminophen) or by increasing the excretion of poisons (eg, choride or mercury diuretics for bromide poisoning). Other systemic antidotes compete with the venom for receptors at their site of action (eg, atropine with muscarine, naloxone with morphine, physostigmine reverses some of the anticholinergic effects of tricyclic antidepressants as well as antihistamines, belladonna, and other atropine-like substances). Specific antidotes are discussed in the sections on individual poisons.

Which doctors should you contact if you have Chemical poisoning:

Surgeon
Infectionist

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You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific symptoms, characteristic external manifestations- so called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

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Other diseases from the group Injuries, poisoning and some other consequences of external causes:

Arrhythmias and heart block in cardiotropic poisoning

Depressed skull fractures

Intra- and periarticular fractures of the femur and tibia

Congenital muscular torticollis

Congenital malformations of the skeleton. Dysplasia

Dislocation of the semilunar bone

Dislocation of the lunate and proximal half of the scaphoid (de Quervain's fracture dislocation)

dislocation of the tooth

Dislocation of the scaphoid

Dislocations of the upper limb

Dislocations and subluxations of the head of the radius

Dislocations of the hand

Dislocations of the bones of the foot

Shoulder dislocations

Dislocations of the vertebrae

Dislocations of the forearm

Dislocations of the metacarpal bones

Dislocations of the foot in Chopart's joint

Dislocations of the phalanges of the toes

Diaphyseal fractures of the leg bones

Chronic dislocations and subluxations of the forearm

Isolated fracture of the diaphysis of the ulna

Deviated septum

tick paralysis

Combined damage

Bone forms of torticollis

Posture disorders

Instability of the knee joint

Gunshot fractures in combination with soft tissue defects of the limb

Gunshot injuries to bones and joints

Gunshot injuries to the pelvis

Gunshot wounds of the upper limb

Gunshot wounds of the lower limb

Gunshot wounds of the joints

gunshot wounds

Burns from contact with a Portuguese man-of-war and a jellyfish

Complicated fractures of the thoracic and lumbar spine

Open damage to the diaphysis of the leg

Open injuries of the bones of the hand and fingers

Open injuries of the elbow joint

Open injuries of the foot

Frostbite

Aconite poisoning

Aniline poisoning

Poisoning with antihistamines

Poisoning with antimuscarinic drugs

Acetaminophen poisoning

Acetone poisoning

Poisoning with benzene, toluene

Pale toadstool poisoning

Poisoning with a poisonous milestone (hemlock)

Halogenated hydrocarbon poisoning

Glycol poisoning

mushroom poisoning

dichloroethane poisoning

smoke poisoning

iron poisoning

Isopropyl alcohol poisoning

Insecticide poisoning

Iodine poisoning

cadmium poisoning

acid poisoning

cocaine poisoning

Poisoning with belladonna, henbane, dope, cross, mandrake

Magnesium poisoning

Methanol poisoning

Methyl alcohol poisoning

Arsenic poisoning

Indian hemp drug poisoning

Hellebore tincture poisoning

nicotine poisoning

Carbon monoxide poisoning

Paraquat poisoning

Smoke poisoning from concentrated acids and alkalis

Poisoning by oil distillation products

Poisoning with antidepressant drugs

Salicylates poisoning

lead poisoning

Hydrogen sulfide poisoning

Carbon disulfide poisoning

Poisoning with sleeping pills (barbiturates)

Fluorine salt poisoning

Poisoning by stimulants of the central nervous system

Strychnine poisoning

Tobacco smoke poisoning

Thallium poisoning

Tranquilizer poisoning

Acetic acid poisoning

Phenol poisoning

Phenothiazine poisoning

Phosphorus poisoning

Poisoning with chlorine-containing insecticides

cyanide poisoning

Ethylene glycol poisoning

Ethylene glycol ether poisoning

Poisoning by calcium ion antagonists

Barbiturate poisoning

Poisoning with beta-blockers

Poisoning with methemoglobin formers

Poisoning by opiates and narcotic analgesics

Poisoning with quinidine drugs

pathological fractures

Fracture of the upper jaw

Fracture of the distal radius

Tooth fracture

Fracture of the bones of the nose

Fracture of the scaphoid

Fracture of the radius in the lower third and dislocation in the distal radioulnar joint (Galeazzi injury)

Fracture of the lower jaw

Fracture of the base of the skull

Fracture of the proximal femur

Fracture of the calvaria

jaw fracture

Fracture of the jaw in the region of the alveolar process

skull fracture

Fracture dislocations in the Lisfranc joint

Fracture and dislocation of the talus

Fractured dislocations of the cervical vertebrae

Fractures II-V metacarpal bones

Hip fractures in the knee joint

Fractures of the femur

Fractures in the trochanteric region

Fractures of the coronoid process of the ulna

Fractures of the acetabulum

Fractures of the head and neck of the radius

Fractures of the sternum

Poisoning with chemical reagents and substances can occur at very various circumstances. In most cases, toxic effects are provoked by household chemicals (cleaning products, powder, detergents) or harmful species fertilizers - if they are used carelessly, as well as drugs, dyes and chemical compounds used in production work.

This type of poisoning is considered the most dangerous! And in this article we will consider how first aid should be provided in case of chemical poisoning, by what signs this type of intoxication can be recognized, and according to what scheme (sequence) it is necessary to act in order to save the life and health of the poisoned person.

How does chemical poisoning happen?

Intoxication with chemicals can be encountered on hazardous industries, during combat operations or even at home. Toxic compounds can enter the body through food and drink, as well as contaminated air. They can penetrate through the skin, mucous surfaces, through the intestines, lungs or bronchi. Therefore, the symptoms of chemical poisoning can be different depending on the way (path) of toxic elements entering the body, because they will affect individual systems and organs.

Poisoning can be caused by accidental ingestion of products with a dangerous chemical composition or by their special use for the purpose of suicide. Also, chemicals can get inside the body due to carelessness and oversight, or during accidents at work. Even the use of detergents and cleaning products with aggressive chemical composition at home can result in shipment if care is not taken when handling them and the rule of using protective equipment (gloves, masks) is neglected.

From all of the above, it follows that chemical compounds can enter the body in 3 specific ways:

through the mouth (esophagus);
through the respiratory tract;
and through the skin and mucous membranes.

Symptoms of chemical poisoning

Chemical poisoning can be various symptoms. It all depends on the substance that got inside the body, and on the mechanism of its action. With a chemical form of poisoning, symptoms may appear immediately, or after a few hours. In addition, they can serve as a defeat various organs and systems.

When toxic substances enter through the mouth

When chemicals enter the body through the mouth, they are rapidly absorbed into the stomach, intestines and bloodstream, after which the toxic effect begins. It is manifested by the following symptoms:

strong pain syndrome in the throat and in the cavity of the stomach;
heartburn;
chemical burn injuries of the mucous membrane of the mouth, esophagus, larynx, stomach or intestines;
feeling of nausea;
persistent vomiting (vomit may be black or deep red, which is a symptom of internal bleeding in the stomach or intestines);
severe diarrhea (with internal bleeding liquid stool will also be black)
dehydration of the body;
gastrointestinal disorder.

Poisoning from caustic compounds such as acid or alkali can lead to ulcerative lesion digestive tract. Through the formed ulcerative defects toxic substances can enter the bloodstream, causing the destruction of blood cells. In this case, yellowness and pallor of the skin surfaces may appear, associated with the death of red blood cells and the release of bilirubin. In addition, alkali and acid can cause a severe chemical burn of the digestive tract.

Through the respiratory tract

When chemical compounds enter the body through the respiratory tract, symptoms such as:

severe shortness of breath;
slow and difficult breathing, inability to exhale;
cough;
strong respiratory failure(up to respiratory arrest);
burn injury of the upper respiratory tract;
bronchospasm;
bluish skin tone or pallor;
expectoration of sputum;
secretion of mucus from the nasal cavity;
lacrimation or, conversely, dryness of the mucous surface of the eyes;
disorientation in space or hallucinations;
violation of the rhythm of the heartbeat (slowdown or acceleration);
loss of consciousness;
pulmonary edema.

If the poison from the respiratory tract enters the gastrointestinal tract, then pain in the abdomen, heartburn, and vomiting will be added to the listed symptoms.

Through the skin and mucous membranes

The nature of the lesion in poisoning caused by contact with chemicals on the skin or mucous membranes will depend on the nature of the chemicals. So, alkalis and acids can cause a burn, and highly toxic compounds will be quickly absorbed into the skin and penetrate into the blood, affecting directly the work internal systems and organs. With this form of poisoning, the following symptoms can be observed:

burn marks varying degrees at the site of contact of the substance with the skin (from redness to blistering or skin corrosion);
signs of an allergic reaction, such as a rash or spots;
strong It's a dull pain at the site of contact with the chemical;
respiratory or heart rhythm problems.

First aid

Emergency care for chemical poisoning should be provided immediately after signs of intoxication are detected. The most important thing is to call an ambulance as soon as possible! Without the help of medical personnel, this type of poisoning is indispensable!

Features of first aid for poisoning through the mouth

First of all, remember that if a person has poisoned himself with alkali or acid, it is absolutely contraindicated to wash his stomach cavity or artificially provoke vomiting! This can cause repeated chemical damage to the mucosa of the esophagus and oral cavity, provoke pain shock and internal bleeding.

In case of poisoning through the esophagus (mouth), it is necessary to act according to the following scheme:

If the poisoned person is unconscious, he should be laid on the floor with his head turned to one side. This position will protect him from choking with outgoing vomit or falling tongue.
If the patient is conscious, it should be clarified with him what exactly caused the poisoning. Then proceed in the sequence described below.
If the poisoning is provoked by the use of medicines, the poisoned person is given to drink (in one gulp) a liter of water and provoke vomiting. Such artificial vomiting is caused by pressing on the root of the tongue. In cases where the patient could not name the chemical that caused the poisoning, or if it is an acid or alkali, washing the stomach cavity is prohibited.
Either way, drinking will help! Offer the victim to drink water (200-300 ml). The liquid will dilute the concentration of chemicals, and thereby reduce them Negative influence to the food tract.
Then you just need to monitor the condition of the poisoned person and wait for the arrival of the doctors. No medicines should be given as you cannot know what kind of reaction they may cause when in contact with chemicals that have entered the body.

In case of respiratory poisoning

First of all, it is necessary to remove the victim to clean fresh air.
It is necessary to unfasten all tight clothing (tie, shirt, scarf) and make sure that nothing prevents the poisoned person from breathing fully.
If a person is conscious, it is better to sit him down, but if he is unconscious, put him on a hard (necessarily flat) surface, turning his head to one side.
You can give him water to drink.

Skin contact with chemicals

If a chemical compound comes into contact with a leather surface, rinse thoroughly under cold running water for at least 15-20 minutes. This will help cleanse the skin of the remnants of toxic elements that have not yet been absorbed into the blood plasma. In addition, cold water will slightly alleviate the pain syndrome.

Health care

The arriving ambulance team needs to tell how the person went, what first symptoms he had, and what help you gave him. After evaluating all the information provided, doctors will determine which scheme should be used to provide first aid.

The following assistance can be provided to the poisoned person:

connection to the device for artificial ventilation of the pulmonary system;
intubation - the introduction of a special endotracheal tube into the trachea to improve airway patency;
lavage of the stomach cavity through a probe;
administration (intravenously) of drug solutions to improve the functioning of the heart, blood vessels and respiratory system.

Hospitalization is carried out as quickly as possible, transporting the patient to the toxicology department.

Further treatment

Duration medical therapy and the prognosis depend on the condition of the poisoned person. At the hospital, he will be given an antidote for the chemical that caused the intoxication (if it exists).

If the patient is in serious condition, it is placed in intensive care unit. Hemodialysis (blood purification procedure) may also be performed.

To identify the affected systems and organs, comprehensive examination patient, including:

complete blood count (CBC);
biochemical blood tests (BAC);
general urinalysis (OAM);
electrocardiogram;
x-ray of the lungs;
a blood test to detect toxins;
Ultrasound (ultrasound internal organs).

Intoxication with chemicals dangerous pathology and a threat to human life and health! Not everyone knows what to do in case of chemical poisoning and how to help the victim. And in such a situation, you need to act very quickly, because every minute counts! The main thing is to immediately call an ambulance and exclude, if possible, the entry of toxic substances into the body! Remember, you cannot do without the help of medical staff in such cases!

Poisoning with household chemicals is not uncommon. In every house there are means for washing dishes and floors, cleaning plumbing, and washing clothes.

Poisoning usually occurs as a result of improper storage of such funds or non-compliance with safety precautions during use.

Most often, children suffer, because all the bottles and packaging are bright and colorful, which attracts the attention of the child.

Description and types of household chemicals

There are several types of household chemicals:

Cosmetics,
Means for washing and cleaning,
insecticides,
Lacquers and paints,
Stain removers.

The composition of cosmetic substances very often contains a variety of alcohols, which, when penetrated, adversely affect the body.

Insecticides are used to get rid of various insects. Most often, the composition includes organophosphorus compounds, poisoning with which is very dangerous.

Plumbing cleaning fluids contain a variety of acids or alkalis. Their poisoning is quite severe for the body.

Stain removers often contain chlorine-containing substances, which are also dangerous. Intoxication with household chemicals gives people a lot of trouble and problems. In severe cases, death is possible.

Causes of poisoning with household chemicals

Poisoning with household chemicals occurs due to different reasons. The main ones are the following:

Failure to follow instructions for use, work in unventilated areas,
Non-compliance with storage rules. Bright labels attract the attention of young children, and they can easily drink liquids containing chemicals.
Frequent use of funds can provoke a gradual accumulation in the body.
It is not uncommon for people to simply confuse chemistry with water and drink it.
Poisoning can cause drugs to come into contact with the skin or mucous membranes.

When it enters the human body, there are disturbances in the functioning of internal organs, respiratory arrest may occur.

Signs and symptoms of chemical poisoning

Symptoms of poisoning with household chemicals are varied. They depend on what exactly happened poisoning and in what way.

It can be:

Nausea,
Vomit,
indigestion, diarrhea,
Painful sensations in the abdomen
lethargy, apathy,
Pain in the head
Throat discomfort, cough
vision problems,
Labored breathing,
foam from the mouth,
convulsions,
Loss of consciousness.

In case of poisoning by means for cleaning plumbing nausea, respiratory irritation may occur if a person inhales the resulting vapors, a rash on the skin.

In case of poisoning with a chlorine-containing substance, a person develops disorders respiratory function and blood circulation.

When absorbed into the blood, some toxic compounds can kill red cells, while the access of oxygen to the organs through the blood is limited. The result can be hypoxia of the brain.

If the chemical gets on the skin, the formation of ulcers, wounds, burns is possible.

When swallowing a poisonous substance, pain in the larynx, vomiting with blood occurs. A chemical odor may come from a person.

If you notice at least some of the symptoms, you must definitely call emergency care.

Treatment and first aid for poisoning

Before the doctors arrive, you need to give the person first aid. It will depend on how the poisoning occurred:

If this happened orally acidic or alkaline substance, it is forbidden to do so. This will provoke increased vomiting, the larynx may swell and the person will begin to choke. You can give the poisoned person more than 600 ml of water as much as possible. Do not try to neutralize the acid with a large amount of alkaline agent and vice versa. The result will be the formation of a lot of carbon dioxide. Bleeding and pain while intensifying. In case of acid poisoning, a little soda is added to the drinking solution, and in case of alkali poisoning, a little citric or acetic acid is added. But this must be done very carefully. But first of all, you need to call an ambulance.
In case of poisoning with cosmetics , on the contrary, it is worth rinsing the stomach. To do this, the victim is given salt water and induces vomiting. If a person has lost consciousness, then his head should be turned to one side so that substances from the stomach do not enter the respiratory tract.
If poisoning with household chemicals has occurred through the respiratory tract, the person should be provided with access to clean air, take off his clothes soaked toxic fumes and unable to breathe normally. Can be rinsed oral cavity weak soda solution.
If household chemicals get on the skin or mucous membranes, then you need to rinse these places with plenty of cool water. The same goes for getting poisons in the eyes.

The final treatment is carried out in medical institutions.

It includes:

If necessary, gastric lavage,
The use of various intravenous solutions,
Blood transfusion,
Prescribe drugs that normalize cardiac activity,
If necessary, use inhalation.

The doctor selects the method of therapy that is most suitable in a particular case.

Dealing with household chemical poisoning is difficult, but quite possible. In this case, it is necessary to comply with all prescriptions of doctors. Timely assistance also plays an important role.

Poisoning with household chemicals: prevention

In order to avoid poisoning, it is enough to know a few rules:

Keep the funds out of the reach of children,
You should not drink from bottles without labels, there may not be water in there,
Follow the rules for using the product. If necessary, wear gloves and a respirator.
Do not store these drugs near food and water.
It is much easier to prevent poisoning than to treat its consequences.

Household chemicals are used in every home, people have long been accustomed to it. Unfortunately, sometimes carelessness in application and storage can lead to poisoning.

If you notice any suspicious symptoms, you should immediately call for emergency help. You should not try to cope on your own, you can only slightly alleviate the patient's condition before the doctors arrive.

Video: how not to get infected with chemistry right in the store

Which doctors should you contact if you have Chemical poisoning

What is chemical poisoning

Poisoning- a set of adverse effects caused by the ingress of a toxic substance into the gastrointestinal tract and respiratory tract or its contact with the skin, eyes or mucous membranes (polystyrene, vagina, etc.).

What causes chemical poisoning

Poisons include certain drugs, household chemicals, solvents, pesticides, and other chemicals.

Symptoms of chemical poisoning

Symptoms of poisoning depend on the type and amount of poison ingested, and the individual characteristics of the victim. Some poisons with low toxicity cause some kind of damage only with prolonged exposure or repeated ingestion in large quantities. Other substances are so poisonous that even a single drop of such a poison on the skin can lead to dire consequences. The toxicity of a substance in each case also depends on the genetic characteristics of a person. Some normally non-toxic substances are toxic to people with a certain genotype (set of genes).

The dose of a substance that causes symptoms of poisoning is also very dependent on age. For example, in a small child, the ingestion of more paracetamol is more likely to cause symptoms of poisoning than the same dose in an adult. For an elderly person, a sedative from the benzodiazepine group (seduxen, relanium, phenazepam) can be toxic in doses that do not cause any disturbance in a middle-aged person.

Symptoms of poisoning may be mild but unpleasant, such as itching, dry mouth, blurred vision, pain, or may be life-threatening, such as disorientation, coma, irregular heartbeat, difficulty breathing, and marked agitation. Some poisons begin to act after a few seconds, while others take several hours or even days after they enter the body.

There are poisons that do not cause obvious symptoms until there is irreversible damage to the function of vital organs, in particular the liver or kidneys. Thus the symptoms of poisoning are as innumerable as the number of poisons.

Diagnosis of chemical poisoning

Optimal management of patients with poisoning requires a correct diagnosis. Although the toxic effects of some chemicals are very characteristic, most of the syndromes seen in poisoning may be due to other diseases.

Poisoning is commonly included in the differential diagnosis of coma, seizures, acute psychosis, acute liver or kidney failure, and bone marrow depression. Although this should be done, the possibility of poisoning can be disregarded when the patient's main manifestations are mild mental or neurological disturbances, abdominal pain, bleeding, fever, hypotension, pulmonary congestion, or skin rash. In addition, the patient may not be aware of the effect of the poison on him, as is the case with chronic, latent poisoning, or after an attempted suicide or abortion, the patient will also not be inclined to agree with such a diagnosis. Physicians should always be aware of the various manifestations of poisoning and maintain a high degree of alertness to them.

In acute accidental poisoning, the active substance may be known to the patient. In many other cases, information can be obtained from relatives or acquaintances, by examining containers located at the site of poisoning, or by interviewing the patient's doctor or pharmacist. Often, such actions allow you to establish only the trade name of the product, which does not allow you to know its chemical composition. The bibliography at the end of this chapter lists a number of books that list the active constituents of substances used in the household, agriculture, patent medicines, and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. The lesser urgency of therapeutic measures in these cases usually allows for the necessary thorough study of the patient's habits and the state of the environment.

Some poisons may cause the development of characteristic clinical signs sufficient to strongly suggest an accurate diagnosis. With a thorough examination of the patient, a characteristic smell of cyanide can be detected; cherry staining of the skin and mucous membranes, revealing the presence of carboxyhemoglobin; pupillary constriction, drooling and hyperactivity of the gastrointestinal tract caused by insecticides containing cholinesterase inhibitors; lead border and paralysis of the extensor muscles, characteristic of chronic lead poisoning. Unfortunately, these typical signs are not always present, and in case of chemical poisoning, their presence is rather an exception.

Chemical analysis of body fluids provides the most correct identification of the substance that caused the poisoning. Some common poisons, such as acetylsalicylic acid (aspirin) and barbiturates, can be detected and even quantified with relatively simple laboratory tests. Other poisons require more complex toxicological studies, such as high-performance gas or liquid chromatography, which are only performed in specialized laboratories. In addition, the results of toxicological studies are rarely available in time to decide on initial treatment for acute poisoning. However, samples of vomit, aspirated stomach contents, blood, urine, and feces should be retained for toxicology testing if diagnostic or legal issues arise. Chemical analysis of body fluids or tissues is especially important in diagnosing and assessing the severity of chronic poisoning. Ultimately, the results of such an analysis are useful for evaluating the long-term results of some types of therapy.

Treatment of chemical poisoning

For the correct treatment of a patient with poisoning, it is necessary to know both the basic principles of managing such patients and the details of therapy for specific poisonings. The treatment process includes:

prevention of further absorption of the poison;
removal of the absorbed poison from the body;
symptomatic supportive therapy or symptomatic treatment for circulatory disorders, respiratory disorders, neurological disorders and impaired renal function;
introduction of systemic antidotes.

Evacuation of stomach contents

Always, if there are no specific contraindications, you should try to empty the stomach. These attempts can be very successful if made soon after the poison has been ingested. Significant amounts of poison can still be expelled from the stomach several hours after ingestion, as gastric emptying may be delayed as a result of gastric atony or pylorospasm. This occurs with poisoning with phenothiazines, antihistamines, and tricyclic antidepressants.

After swallowing many poisons, vomiting occurs spontaneously. In a smaller number of cases, it can be induced at home by mechanical stimulation of the back of the throat. The emetic effect of ipecac syrup (the concentration should not exceed more than 14 times the concentration of the liquid extract), given in a dose of 15 - 30 ml, is more effective and safe even at home. Its action begins an average of 20 minutes after ingestion and depends in part on absorption in the gastrointestinal tract, so the simultaneous administration of activated charcoal, which is an adsorbent, should be avoided. A second dose of ipecac syrup should be given to the patient if he does not vomit 20 minutes after taking the first dose (after taking two doses, vomiting will develop in 90-95% of patients). If there is no scrap of ipecac syrup, every effort should be made to find it, even if this requires taking the patient to the hospital. Apomorphine administered intramuscularly at a dose of 0.06 mg/kg acts within 5 minutes, but may cause prolonged vomiting. When administered intravenously at a dose of 0.01 mg/kg, apomorphine induces vomiting almost immediately, with no subsequent effect on the central nervous system. Sometimes it is not possible to induce vomiting and valuable time should not be wasted waiting. An attempt to induce vomiting should not be made in victims who are in a convulsive state, in patients with severe central nervous system depression, or (due to the risk of perforation of the stomach or esophagus or due to aspiration of vomit into the trachea) in persons who have swallowed a potent caustic chemical or small amounts (less than 100 ml) of liquid hydrocarbons that are strong lung irritants (eg, kerosene, polish).

Compared to vomiting, gastric lavage is more preferable and acts immediately, but it usually does not remove poison from the stomach more effectively than vomiting. It can be performed in patients who are unconscious, the evacuation of the contents of the stomach reduces the risk of aspiration of vomit. Its performance, however, is contraindicated after ingestion of strong corrosive substances, because of the danger of perforation of damaged tissues. When performed correctly, gastric lavage carries a small risk of aspiration of stomach contents into the lungs. The patient should lie on his stomach with his head and shoulders down. Using a mouth expander, a gastric tube is introduced into the stomach, the diameter of which is sufficient to pass solid particles (30 gauge). If the functions of the central nervous system are depressed, if the insertion of the probe causes vomiting, or if a substance that is an irritant to the lungs has been swallowed, it is reasonable to introduce a cuffed endotracheal tube into the trachea before performing gastric lavage. The contents of the stomach are aspirated with a large syringe, and with it most of the poison is removed from the body. After that, 200 ml (in children less) of warm water or liquid solution is injected into the stomach and aspirated until the aspirated liquid becomes clear.

Interference with absorption in the gastrointestinal tract.

Adsorption by activated carbon is a reversible process and the efficiency of adsorption of many poisons varies depending on the pH value. Acidic substances are better adsorbed by acid solutions and therefore can be released in the small intestine. It is desirable that activated charcoal with adsorbed poison pass through the intestines as quickly as possible. This will also reduce intestinal absorption of any unadsorbed poison that has passed through the pylorus. In patients with good renal and cardiac function, this is best achieved by oral or intramuscular administration of osmotic laxatives. agents such as magnesia or sodium sulfate (10 - 30 g in a solution with a concentration of 10% or less).

The systemic distribution of injected poisons can be slowed by applying a cold compress or ice to the injection site, or by applying a tourniquet proximal to the injection site.

After inhalation of toxic gases, vapors or dusts, remove the victim to clean air and maintain adequate ventilation. The patient cannot move, he should wear a protective mask.

Bile excretion

Urinary excretion

Acceleration of renal excretion is justified in cases of poisoning by a much larger number of poisons. Renal excretion of toxic substances depends on glomerular filtration, active tubular secretion and passive tubular resorption. The first two of these processes can be protected by maintaining adequate circulation and kidney function, but in practical terms, they cannot be accelerated. On the other hand, passive tubular resorption of many poisons plays an important role in increasing their duration of action and can often be reduced by readily available methods. In poisoning with drugs such as salicylic acid preparations and long-acting barbiturates, the effectiveness of increased diuresis induced by the administration of large volumes of electrolyte solutions in combination with intravenous furosemide has been demonstrated in increasing renal excretion.

Changing the pH of urine can also inhibit the passive reversible diffusion of some poisons and increase their renal clearance. The epithelium of the renal tubules is more permeable to uncharged particles than to ionized solutions. Weak organic acids and bases readily diffuse out of the tubular fluid in their non-ionized form, but are retained in the tubules if they are ionized. Acidic poisons are ionized only at a pH exceeding their pK. Alkalinization of urine sharply increases the ionization in the tubular fluid of such organic acids as phenobarbital and salicylate. In contrast, the pKa of pentobarbital (8.1) and secobarbital (8.0) are so high that renal clearance does not increase markedly with an increase in urine pH within the physiological alkaline range. Alkalinization of urine is achieved by infusion of sodium bicarbonate at a rate determined by the pH value of urine and blood. Severe systemic alkalosis or electrolyte disturbances should be avoided. The combination of induced diuresis with alkalinization of the urine can increase the renal clearance of some acidic poisons by a factor of 10 or more, and these measures have been found to be very effective in salicylates, phenobarbital, and 2,4-dichlorophenoxyacetic acid poisoning. Conversely, lowering the pH below its normal values has been shown to increase the clearance of amphetamines, phencyclidines, fenfluramine, and quinine.

Dialysis and hemosorption

Dialysis has been found to be effective in removing many substances from the body, including barbiturates, borate, chlorate, ethanol, glycols, methanol, salicylates, sulfonamides, theophylline, and thiocyanate. Theoretically, it should accelerate the elimination from the body of any dialyzable toxin that is not irreversibly bound to the tissues. Its effectiveness does not extend to large molecules, non-dialysable poisons, and is reduced to a large extent by the binding of the toxic substance to proteins or its solubility in fats.

Hemodialysis is undeniably more effective in removing large amounts of dialysable poisons from the body. For barbiturates, dialysis rates of 50–100 ml/min have been achieved, while the rate of excretion from the body is 2–10 times higher than with peritoneal dialysis or forced diuresis. With blood perfusion through activated charcoal or ion-exchange resin, even greater clearance rates of most poisons are achieved than with hemodialysis. Clearly, extracorporeal dialysis and hemosorption may be considered the procedures of choice for the rapid elimination of poisons from the body of patients who have absorbed such amounts of poison as to make their survival unlikely even with the best supportive care. Since not every hospital has the necessary equipment and experienced staff for hemodialysis and hemosorption, consideration should be given to transferring such patients to a facility with such facilities.

supportive therapy. Most chemical poisonings are reversible, self-limiting disease states. Skillful supportive care can save the lives of many severely poisoned patients and keep their detoxifying and excretory mechanisms functioning until the poison concentration is reduced to safe levels. Symptomatic measures are especially important when the active poison belongs to the category of substances for which a specific antidote is unknown. Even when an antidote is available, vital signs should be prevented or controlled with appropriate supportive care.

Depression of the central nervous system. Specific therapy aimed at combating the inhibitory effect of poisons on the central nervous system is usually neither necessary nor difficult. Most patients with poisoning come out of a coma, as from a long anesthesia. During the unconscious period, careful care of the nurse and close observation of the patient are necessary. If the depression of the centers located in the medulla oblongata occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using chemical means and mechanical procedures. The use of analeptics in the treatment of patients with poison-induced central nervous system depression has been largely abandoned. It is certain that these substances should never be used to awaken consciousness, and it is doubtful that their use to hasten the recovery of spontaneous breathing and active reflexes has ever been justified. In contrast, the drug antagonist naloxone, administered intravenously in adequate doses, usually reverses the central nervous system depression associated with drug overdose.

Seizures. Many poisons (eg, chlorinated hydrocarbons, insecticides, strychnine) cause seizures due to their specific stimulating effect. In patients with poisoning, convulsions may also occur due to hypoxia, hypoglycemia, cerebral edema, or metabolic disorders. In such cases, these violations should be corrected as far as possible. Regardless of the cause of seizures, it is often necessary to use anticonvulsants. Intravenous diazepam, phenobarbital, or phenytoin are usually effective.

Cerebral edema. An increase in intracranial pressure due to cerebral edema is also a characteristic sign of the action of some poisons and a non-specific consequence of other chemical poisonings. For example, cerebral edema is observed in case of poisoning with lead, carbon monoxide and methanol. Symptomatic treatment consists of the use of adrenocorticosteroids and, when necessary, intravenous administration of hypertonic solutions of mannitol or urea.

Hypotension. The causes of hypotension and shock in the poisoned patient are numerous and often there are several causes at the same time. Poisons can cause depression of the vasomotor centers in the medulla, block the autonomic ganglia or adrenergic receptors, directly inhibit the tone of the smooth muscles of the arteries or veins, reduce myocardial contractility, or induce the appearance of cardiac arrhythmias. Less specific is when the poisoned patient is in shock due to tissue hypoxia, extensive tissue destruction by corrosives, loss of blood and fluid, or metabolic disorders. If possible, these violations should be corrected. If the central venous pressure is low, then the first therapeutic action should be to replenish the volume of fluid in the body. Vasoactive drugs are often useful and sometimes necessary in the treatment of a poisoned patient who develops hypotension, especially in shock due to central nervous system depression. As with shock due to other causes, the choice of the most appropriate drug requires an analysis of hemodynamic disturbances, which is carried out after measuring the value of blood pressure.

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may operate simultaneously. Inadequate ventilation may result from central respiratory depression, muscle paralysis or airway obstruction with accumulated secretions, laryngeal edema, or bronchospasm. Alveolar-capillary diffusion may be impaired in pulmonary edema. Anemia, methemoglobinemia, carboxyhemoglobinemia, or shock can impair oxygen transport. Inhibition of cellular oxidation may occur (eg, cyanides, fluoroacetate). For treatment, it is necessary to maintain adequate airway patency. The clinical situation and site of the obstruction may indicate frequent suctioning, insertion of an oropharyngeal airway or endotracheal tube, or tracheotomy. If, despite normal airway patency, ventilation remains inadequate, as evidenced by the clinical condition or measurement of minute volume or blood gases, mechanical ventilation by appropriate mechanical means is imperative. In tissue hypoxia, the introduction of high concentrations of oxygen is always indicated. In cases where there is severe depression of the central nervous system, the introduction of oxygen often leads to respiratory arrest and must be accompanied by artificial ventilation.