Chronic intoxication of the body. How to remove intoxication of the body at home. The diagnosis of intoxication of the body

Everyone knows such an ailment as a cold or SARS - both children and adults. Runny nose and cough, chills, muscle aches, and fever. All these symptoms indicate the presence of a viral acute infection. Viral diseases are dangerous not only with complications of the upper respiratory tract that appear after an illness. During the height of the disease itself or after it, the body often cannot withstand the load. In some cases, when vital organs are infected, an intoxication syndrome appears.

The syndrome of intoxication manifests itself in each person in different ways, but the passage of a viral infection worsens significantly. What are the symptoms of intoxication with SARS in children and adults? How to remove the intoxication of the body and help it reduce the harmful effects of the disease?

Most often, infectious diseases are accompanied by symptoms of general intoxication. SARS is no exception. Fever, constant headache, joint pain, body aches, vomiting and nausea are symptoms of toxic damage to the body, which explain the poor health of a person.

Such complaints, expressed to a certain extent, cause almost all common seasonal viruses. But the clear leader can be called the flu.

In addition to the above complaints, as a rule, there are:

• G dizziness;
• general weakness;
• muscle pain;
• loss of taste and loss of appetite;
• lowering blood pressure.

In 50% of cases with ARVI, these symptoms are ahead of the typical manifestations of a cold: sore throat, cough, runny nose. During a severe course of the disease, it may appear toxic shock accompanied by a sharp drop in blood pressure.

Causes of intoxication

Almost all systems and organs in the human body are exposed to infectious toxic damage, but the central nervous system is most affected. All the more difficult for intoxication of the body to endure children, especially small ones. They have not yet fully formed the mechanisms of resistance to the disease. Intoxication can be caused directly by viral particles, decay products of disease-infected cells of the human body and macrophages - immune defense cells. The result of the toxic effects of this is the effect of pathogenic active biological substances on vascular tissue, which leads to edema and an increase in its permeability.

Complicated passage of intoxication of the body

Deterioration after temporary stabilization, lack of effect from the treatment being performed, or prolonged fever are alarming symptoms of the onset of complications, especially during the flu. A high probability of developing infectious toxic shock, which is accompanied by respiratory and cardiovascular failure, acute infection of the central nervous system in the form of cerebral edema and seizures, blood clotting disorder.

How to remove intoxication of the body at home?

The intensity of therapeutic measures will depend directly on the level of severity of intoxication of the body. In mild situations, which almost always occur with a certain type of SARS, treatment can be done at home. The treatment algorithm looks like this.

Mode

Provide peace to the patient. Recommended half-bed or bed rest with limited TV viewing and good sleep. The room in which the patient is located must be periodically ventilated. This will reduce the concentration of viral microparticles and intoxication products in the air, which are excreted with sweat and inhaled with air. The patient can be in the room - it is only necessary to cover him well. When the air is dry, which is most often the case in winter in heated rooms, damp towels can be hung on the radiators. If money allows, then buy a special humidifier.

Diet

In case of intoxication, heavy fried and fatty foods are prohibited. The best option can be considered dairy and plant based diet sparing the liver and gastrointestinal tract. It is necessary to limit the consumption of meat food. Preference should be given to cottage cheese products and cereal dishes. Do not get carried away with dishes of complex culinary processing, as well as sweets. Very important kind to the liver, since this organ is the main tool in the body for the removal of toxins of various origins during intoxication.

If the patient refuses to eat, do not force-feed him, it is better provide the person with sufficient fluids. A good folk remedy that strengthens the body is low-fat chicken broth, which you can just drink. Together with the broth, you can offer a dried piece of bread.

With the help of an adequate water load, you can independently cope with toxins without resorting to pharmaceutical products. Compotes and fruit drinks from dried and frozen berries, dried fruits, even simple purified drinking water cope well with the tasks. Decoctions and infusions of dried fruits have diuretic properties, and also contain the necessary trace elements.

Rosehip, viburnum, raspberry and linden decoctions help reduce intoxication and have a pronounced diaphoretic property. The use of warm mineral waters will further contribute to the liquefaction of pathological discharge and sputum from the nose. Water must be non-carbonated! For an adult, the volume of water load must reach at least 2 liters.

Drug treatment for intoxication

To do this, prescribe antiviral agents that affect the virus itself (Lavomax, Remavir, Arbidol). The second group of medicines are stimulators of the body's synthesis of its interferon (mefenamic acid).

Prescribing antibiotics on your own is strongly discouraged.. This group of drugs is necessary only if there are symptoms of bacterial complications. Their unreasonable use depletes the immune system and causes the body's resistance to this treatment in the future.

Naturally, elevated temperature exacerbates poor health. However, fever is a protective reaction of the body. During a high temperature, interferon, which is involved in immune reactions, begins to be intensively produced.

Sorbents can help remove toxins: white coal, Enterosgel, Polysorb, Atoxil. You can even purchase plain activated charcoal.

Recently, complex remedies for symptomatic treatment have gained great popularity, which in their composition have ascorbic acid, paracetamol or antiallergic substances - phenylephrine and pheniramine. They are sold under various brand names: Theraflu, Fervex, Coldrex, etc.

Their main advantages:

• Dosages are selected taking into account the main indication: the treatment of acute respiratory viral infections.
• They quickly remove the unpleasant symptoms of flu and other colds: fever, aches, nasal congestion, sore throat and muscle pain.
• A convenient form of production in the form of a hot drink with a pleasant aftertaste. Allows you to comfortably perform treatment even at work and take one remedy instead of three.

An important role belongs to ascorbic acid - vitamin C. It reduces the effects of edema and reduces the permeability of the vascular wall.

Treatment for intoxication of the body with folk methods

Treatment must be comprehensive., in addition to developing a diet and taking medications, you can add folk remedies. Decoctions and infusions based on medicinal herbs will speed up the release of toxic elements from the body. Consider the most popular recipes that have been tested by time:

• Poisoning can be cured with rosehip decoction. To prepare it, you need to add 50 gr. to one liter of pure water. berries and cook for 3 hours. The broth is filtered, the container is moved to a warm place, and allowed to brew for another 5 hours. Then bring the infusion to a boil, add honey in the amount of 50 g to the medicinal composition. This mixture is taken in the morning and evening, 200 ml.
• Great can help decoction of viburnum to prepare it, you need to pour 50 g of water with a liter of water. berries (fruits can be replaced with viburnum leaves in the amount of 100 gr.). Bringing this mixture to a boil, it is kept on low heat for one hour, filtered and cooled. Reception is performed between meals, during the day it is necessary to completely drink the volume of the prepared composition.
• Aloe leaves can be used against intoxication. The leaves of this plant are cut off the day before the preparation of the composition and placed in the refrigerator, wrapped in a film. After 300 gr. the plants are finely chopped, honey is added in a volume of 200 g, mixed and the composition is allowed to brew for a week. Applied before meals, 50 gr.
• At home, a tincture made from blackcurrant leaves can help to cope with the elimination of toxins. To create a remedy, blackcurrant leaves are finely chopped, transferred to a half-liter bottle, a vodka solution is added (water and vodka are taken in equal parts). The jar is tightly sealed, rearranged in a dark place, the composition is ready for use in three days. To obtain a single dose of the medicinal composition, 100 ml of water is mixed with 20 drops of the agent. It is necessary to apply the medicine half an hour before meals in the morning and evening. It should be borne in mind that this recipe is contraindicated for children and pregnant women.
• In the summer, watermelon can help improve the condition, its peels must be washed, cut into small pieces, transferred to a container, adding for every 100 g. a liter of water. All this must be cooked for one hour. After the peel is removed, juice is added to the composition, which is squeezed from 2 lemons. The medicine is taken in any volume.

How to return to normal life?

When the main course of therapy is completed, the sick leave is closed, the person quite often continues to experience loss of appetite and weakness. There may be slight increases in temperature in the evening - these are the so-called temperature "tails".

How to restore strength and alleviate the condition? The following recommendations may be taken into account:

• Useful is a course of multivitamins or just a complete diet, balanced in all the main components of the daily menu: carbohydrates, fats and proteins. The diet is bound to itself include the required amount of fruits and vegetables - sources of vitamins.
• During the fight against infection, the liver experiences a very high load. You can complete a course of rehabilitation treatment with hepatoprotectors for a month. This group of herbal remedies reduces the effects of intoxication.

The fight against intoxication of the body, which causes a deterioration in well-being and many unpleasant symptoms, Properly selected antiviral therapy is the key to successful treatment and prevention of severe consequences, most dangerous for weak patients and children.

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Description:

Intoxication (Greek τοξικός - poisonous) is a disease state caused by the action on the body of exogenous toxins (eg, microbial) or harmful substances of endogenous origin (eg, with toxicosis of pregnant women, thyrotoxicosis).

      * Unlike the word poisoning, the word intoxication in Russian has a narrower, professional meaning, and describes the phenomenon itself, but not the external influence (compare: "Rasputin's poisoning").

Symptoms:

There are two periods during toxicosis.

      * The first period is the period of generalized reaction. It has various course options: toxicosis with encephalic syndrome, toxic encephalopathy, neurotoxicosis, intestinal toxicosis, toxicosis with dehydration (toxicosis with intestinal syndrome), Kishsh toxicosis (hypermotile toxicosis), fulminant form of toxicosis, Waterhouse-Friderichsen syndrome (toxicosis with acute adrenal insufficiency) .
      * The second period - the period of localization of the pathological process can be characterized by the following options - Reye's syndrome (toxicosis with liver failure), Gasser's syndrome, Hemolytic-Uremic syndrome (toxicosis with acute renal failure) and toxicoseptic condition.

In children, risk factors for toxicosis are birth injuries or the presence of congenital and hereditary diseases of the central nervous system, metabolic disorders, previous vaccinations, past infections, etc.

During a generalized reaction, neurological disorders dominate in the picture of toxicosis, the state of "unnatural" sleep alternates with periods of excitement. With the development of a coma, a complete loss of consciousness may occur.

The cardiovascular system will be dominated by peripheral blood flow disorders, "marbling" of the skin, loud, clapping heart sounds, decreased blood pressure, diuresis. Dysfunctions of the gastrointestinal tract in toxicosis are manifested by vomiting, diarrhea, intestinal paresis, anorexia.

Damage to the liver and kidneys with toxicosis is characteristic and constant. Indispensable components of the clinical picture of toxicosis are the pathology of water-electrolyte metabolism deviations in the acid-base state. expressed to varying degrees: from single petechiae on the skin and mucous membranes to profuse evidence of disseminated intravascular coagulation.

Causes of occurrence:

Many diseases and poisonings are accompanied by intoxication. There is intoxication against the background of acute adrenal insufficiency (Waterhouse-Frideriksen syndrome), during pregnancy, sepsis, high fever, in almost all infectious diseases.

Treatment:

For treatment appoint:

Intoxication implies complex treatment - first aid, removal of poisons from the body, identification of the causes of poisoning and the subsequent introduction of specific antidotes. For the treatment of pregnant women, as a rule, outpatient treatment is prescribed, followed by monitoring of body weight dynamics. As for vomiting of the second and third degree (moderate and severe), it requires treatment in a hospital. The doctor diagnoses the severity of vomiting based on the results of studies: clinical and biochemical blood tests, urinalysis, ECG and assessment of the general condition (pulse, complaints, etc.). It is necessary to deal with the manifestations of early toxicosis in a complex manner. Treatment includes drugs that affect the central nervous system, normalize endocrine and metabolic disorders, vitamins and antihistamines. In addition to the prescribed treatment, it is necessary to observe the medical and protective regimen. Usually, hospital staff try not to put two women with this disease in the same room, as a recovering woman may experience a relapse.   Severe requires emergency care. Indications for termination of pregnancy will be: severe general condition treatment failure in the next 6-12 hours development of acute yellow development of acute renal failure.

The complex of methods for the treatment of poisoning includes the following:

      * First aid, resuscitation, if possible - immediate removal of the poison from the body, accurate identification of the cause of poisoning, the introduction of specific antidotes;
      * rehabilitation

Intoxication of the body almost always accompanies a severe injury and, in this sense, is a universal phenomenon, which, from our point of view, has not always been given enough attention. In addition to the word "intoxication", the term "toxicosis" is often found in the literature, which includes the concept of the accumulation of toxins in the body. However, in a strict interpretation, it does not reflect the body's reaction to toxins, i.e., poisoning.

Even more controversial in terms of semantics is the term "endotoxicosis", meaning the accumulation of endotoxins in the body. Considering that endotoxins are traditionally called toxins secreted by bacteria, it turns out that the concept of "endotoxicosis" should be applied only to those types of toxicosis that are of bacterial origin. Nevertheless, this term is used more widely and is used even when it comes to toxicosis due to the endogenous formation of toxic substances that are not necessarily associated with bacteria, but appear, for example, as a result of metabolic disorders. This is not entirely correct.

Thus, to refer to poisoning that accompanies severe mechanical injury, it is more correct to use the term "intoxication", which includes the concept of toxicosis, endotoxicosis and the clinical manifestations of these phenomena.

An extreme degree of intoxication can lead to the development of toxic or endotoxin shock, which occurs as a result of exceeding the adaptive capabilities of the body. In the conditions of practical resuscitation, toxic or endotoxin shock most often completes a crash syndrome or sepsis. In the latter case, the term "septic shock" is often used.

Intoxication in severe shock trauma manifests itself early only in those cases when it is accompanied by large tissue crushing. However, on average, the peak of intoxication falls on the 2-3rd day after the injury, and it is at this time that its clinical manifestations reach their maximum, which together constitute the so-called intoxication syndrome.

Causes of intoxication of the body

The idea that intoxication always accompanies severe trauma and shock appeared at the beginning of our century in the form of a toxemic theory of traumatic shock proposed by P. Delbet (1918) and E. Quenu (1918). A lot of evidence in favor of this theory was presented in the works of the famous American pathophysiologist W. B. Cannon (1923). The theory of toxemia was based on the fact of the toxicity of crushed muscle hydrolysates and the ability of the blood of animals or patients with traumatic shock to retain toxic properties when administered to a healthy animal.

The search for a toxic factor, intensively carried out in those years, did not lead to anything, except for the works of H. Dale (1920), who discovered histamine-like substances in the blood of victims with shock and became the founder of the histamine theory of shock. His data on hyperhistaminemia in shock were confirmed later, but the monopathogenetic approach to explaining intoxication in traumatic shock was not confirmed. The fact is that in recent years a large number of compounds formed in the body during trauma have been discovered, which claim to be toxins and are pathogenetic factors of intoxication in traumatic shock. A picture of the origin of toxemia and its accompanying intoxication began to emerge, which is associated, on the one hand, with a multitude of toxic compounds formed during trauma, and, on the other hand, due to endotoxins of bacterial origin.

The vast majority of endogenous factors are associated with protein catabolism, which increases significantly with shock injury and averages 5.4 g/kg-day at a rate of 3.1. The breakdown of muscle protein is especially pronounced, increasing by 2 times in men and 1.5 times in women, since muscle hydrolysates are particularly toxic. The threat of poisoning is carried by the products of protein breakdown in all fractions, from high molecular weight to final products: carbon dioxide and ammonia.

If we talk about protein breakdown, then any denatured protein of the body that has lost its tertiary structure is identified by the body as foreign and is the object of attack by phagocytes. Many of these proteins, which appear as a result of trauma or tissue ischemia, become antigens, i.e., bodies to be removed, and, due to their redundancy, are capable of blocking the reticuloendothelial system (RES) and leading to detoxification insufficiency with all the ensuing consequences. The most serious of these is a decrease in the body's resistance to infection.

A particularly large number of toxins are found in the medium-molecular fraction of polypeptides formed as a result of protein breakdown. In 1966, A. M. Lefer and C. R. Baxter independently described myocardiodepressive factor (MDF), which is formed during shock in the ischemic pancreas and is a polypeptide with a molecular weight of about 600 daltons. In the same fraction, toxins causing RES depression were found, which turned out to be ring-shaped peptides with a molecular weight of about 700 daltons.

A higher molecular weight (1000-3000 daltons) was determined for a polypeptide that is formed in the blood during shock and causes lung damage (we are talking about the so-called adult respiratory distress syndrome - ARDS).

American researchers A. N. Ozkan et al. in 1986, they reported the discovery of glycopeitide with immunosuppressive activity in the blood plasma of polytraumatized and burn patients.

Interestingly, in some cases, substances that perform physiological functions under normal conditions acquire toxic properties. An example would be endorphins, which belong to the group of endogenous opiates, which, when overproduced, can act as breath suppressants and cause cardiac depression. Especially a lot of this kind of substances is found among the low molecular weight products of protein metabolism. Such substances can be called facultative toxins, in contrast to obligate toxins, which always have toxic properties.

Protein-derived toxins

An example of facultative toxins in shock is histamine, which is formed from the amino acid histidine, and serotonin, which is a derivative of another amino acid, tryptophan. Some researchers refer to facultative toxins and catecholamines, formed from the amino acid phenylalanine.

Significant toxic properties are possessed by the final low molecular weight products of protein breakdown - carbon dioxide and ammonia. First of all, this applies to ammonia, which, even in relatively low concentrations, causes brain dysfunction and can lead to coma. However, despite the increased production of carbon dioxide and ammonia in the body during shock, hypercarbia and ammonia do not seem to be of great importance in the development of intoxication due to the presence of powerful systems for neutralizing these substances.

Among the factors of intoxication are also peroxide compounds formed during shock trauma in significant quantities. Usually, redox reactions in the body consist of fast-flowing stages, at which unstable, but very reactive radicals are formed, such as superoxide, hydrogen peroxide and OH "radical, which have a pronounced damaging effect on tissues and thus lead to protein breakdown. During shock, the transience of redox reactions decreases, and at its stages, the accumulation and release of these peroxide radicals occur. Another source of their formation may be neutrophils, which secrete peroxides as a microbicidal agent as a result of an increase in their activity. The peculiarity of the action of peroxide radicals is that they are able to organize a chain reaction, in which lipid peroxides, formed as a result of interaction with peroxide radicals, become participants, after which they become a tissue damage factor.

Activation of the described processes observed in shock trauma is, apparently, one of the serious factors of intoxication in shock. The fact that this is so is evidenced, in particular, by the data of Japanese researchers who, in experiments on animals, compared the effect of intra-arterial administration of linoleic acid and its peroxides at a dose of 100 mg/kg. In observations with the introduction of peroxides, this led to a 50% decrease in cardiac index 5 minutes after injection. In addition, total peripheral resistance (TPR) increased, pH and excess blood base decreased markedly. In dogs treated with linoleic acid, changes in the same parameters were insignificant.

It is necessary to dwell on one more source of endogenous intoxication, which for the first time in the mid-70s. drew the attention of R. M. Hardaway (1980). We are talking about intravascular hemolysis, and the toxic agent is not free hemoglobin moving from the erythrocyte to the plasma, but the erythrocyte stroma, which, according to R. M. Hardaway, causes intoxication due to proteolytic enzymes localized on its structural elements. M. J. Schneidkraut, D. J. Loegering (1978), who studied this issue, found that the stroma of erythrocytes is very quickly removed from the circulation by the liver, and this, in turn, leads to depression of RES and phagocytic function in hemorrhagic shock.

In later periods after injury, poisoning of the body with bacterial toxins becomes an essential component of intoxication. At the same time, the possibility of both exogenous and endogenous intake is allowed. At the end of the 50s. J. Fine (1964) was the first to suggest that the intestinal flora under conditions of a sharp weakening of the RES function during shock can cause a large amount of bacterial toxins to enter the circulation. This fact was later confirmed by immunochemical studies, which revealed that with various types of shock in the blood of the portal vein, the concentration of lipopolysaccharides, which are a group antigen of intestinal bacteria, increases significantly. Some authors believe that the nature of endotoxins are phosphopolysaccharides.

So, the ingredients of intoxication in shock are numerous and heterogeneous, but the vast majority of them are antigenic in nature. This applies to bacteria, to bacterial toxins, and to polypeptides that are formed as a result of protein catabolism. Apparently, other substances with a lower molecular weight, being haptens, can play the role of an antigen by combining with a protein molecule. In the literature devoted to the problems of traumatic shock, there is information about the excessive formation of auto- and heteroantigens in severe mechanical trauma.

Under conditions of antigenic overload and functional blockade of RES in severe trauma, an increase in the frequency of inflammatory complications occurs, proportional to the severity of injury and shock. The frequency of occurrence and severity of inflammatory complications correlate with the degree of impairment of the functional activity of various populations of blood leukocytes as a result of exposure to mechanical trauma on the body. The main reason, obviously, is associated with the action of various biologically active substances in the acute period of injury and metabolic disorders, as well as the influence of toxic metabolites.

Symptoms of intoxication of the body

Intoxication in shock trauma is characterized by a variety of clinical signs, many of which are nonspecific. Some researchers refer to them such indicators as hypotension, rapid pulse, rapid breathing.

However, based on clinical experience, it is possible to identify signs that are more closely related to intoxication. Among these signs, encephalopathy, thermoregulation disorders, oliguria and dyspeptic disorders are of the greatest clinical importance.

Usually, in victims with traumatic shock, intoxication develops against the background of other signs characteristic of shockogenic trauma, which can enhance its manifestations and severity. These signs include hypotension, tachycardia, tachypnea, etc.

Encephalopathy refers to reversible disorders of the functions of the central nervous system (CNS) resulting from the effects of circulating toxins in the brain tissue. Among a large number of metabolites, ammonia, one of the end products of protein catabolism, plays an important role in the development of encephalopathy. It has been experimentally established that intravenous administration of a small amount of ammonia leads to the rapid development of cerebral coma. This mechanism is most likely in traumatic shock, since the latter is always accompanied by increased protein breakdown and a decrease in detoxification potential. A number of other metabolites, which are formed in increased amounts during traumatic shock, are related to the development of encephalopathy. G. Morrison et al. (1985) reported that they studied the fraction of organic acids, the concentration of which increases significantly in uremic encephalopathy. Clinically, it is manifested by adynamia, severe drowsiness, apathy, lethargy, indifferent attitude of patients to the environment. The increase in these phenomena is associated with a loss of orientation in the environment, a significant decrease in memory. A severe degree of intoxication encephalopathy may be accompanied by delirium, which, as a rule, develops in victims who have abused alcohol. At the same time, intoxication is clinically manifested in a sharp motor and speech excitation and complete disorientation.

Usually the degree of encephalopathy is assessed after communication with the patient. There are mild, moderate and severe degrees of encephalopathy. For an objective assessment of it, judging by the experience of clinical observations in the departments of the Research Institute for Emergency Medicine. I. I. Dzhanelidze, you can use the Glasgow coma scale, which was developed in 1974 by G. Teasdale. Its use makes it possible to parametrically assess the severity of encephalopathy. The advantage of the scale is regular reproducibility even when it is calculated by nursing staff.

With intoxication in patients with shock trauma, a decrease in the rate of diuresis is observed, the critical level of which is 40 ml per minute. A decrease to a lower level indicates oliguria. In cases of severe intoxication, a complete cessation of urine output occurs and uremic encephalopathy joins the phenomena of toxic encephalopathy.

Glasgow coma scale

Dyspeptic disorders as manifestations of intoxication are much less common. Clinical manifestations of dyspeptic disorders include nausea, vomiting, diarrhea. More often than others, nausea and vomiting occur, which are caused by toxins of endogenous and bacterial origin circulating in the blood. Based on this mechanism, vomiting during intoxication refers to hematogenous-toxic. It is characteristic that dyspeptic disorders during intoxication do not bring relief to the patient and proceed in the form of relapses.

Forms

Crash Syndrome

The predominance of toxicosis in the acute period is clinically manifested in the form of the development of the so-called crash syndrome, which was described by N. N. Elansky (1950) as traumatic toxicosis. Usually, this syndrome accompanies crushing of soft tissues and is characterized by the rapid development of disorders of consciousness (encephalopathy), a decrease in diuresis up to anuria, and a gradual decrease in blood pressure. Diagnosis is usually not difficult. Moreover, by the type and localization of the crushed wound, one can quite accurately predict the development of the syndrome and its outcome. In particular, crushing of the thigh or its avulsion at any level leads to the development of fatal intoxication in the event that amputation is not performed. Crushing of the upper and middle third of the lower leg or upper third of the shoulder is always accompanied by severe toxicosis, which can still be managed with intensive treatment. Crushing of the more distal segments of the extremities is usually not so dangerous.

Laboratory data in patients with crush syndrome are quite characteristic. According to our data, the greatest changes are characteristic of the level of SM and LII (0.5 ± 0.05 and 9.1 ± 1.3, respectively). These indicators reliably distinguish patients with crush syndrome from other victims with traumatic shock who had significantly different levels of SM and LII (0.3 ± 0.01 and 6.1 ± 0.4). 14.5.2.

Sepsis

Patients who have undergone an acute period of traumatic illness and the early toxicosis accompanying it may then again be in a serious condition due to the development of sepsis, which is characterized by the addition of intoxication of bacterial origin. In most observations, it is difficult to find a clear temporal boundary between early toxicosis and sepsis, which in patients with trauma usually constantly pass into each other, creating a symptom complex mixed in pathogenetic terms.

In the clinical picture of sepsis, encephalopathy remains pronounced, which, according to R. O. Hasselgreen, I. E. Fischer (1986), is a reversible dysfunction of the central nervous system. Its typical manifestations are agitation, disorientation, which then turn into stupor and coma. Two theories of the origin of encephalopathy are considered: toxic and metabolic. In the body during sepsis, a myriad of toxins are formed, which can have a direct effect on the central nervous system.

Another theory is more specific and proceeds from the fact of increased formation of aromatic amino acids during sepsis, which are precursors of such neurotransformers as norepinephrine, serotonin, dopamine. Derivatives of aromatic amino acids displace neurotransmitters from synapses, which leads to disorganization of the central nervous system and the development of encephalopathy.

Other signs of sepsis - hectic fever, malnutrition with the development of anemia, multiple organ failure are typical and are usually accompanied by characteristic changes in laboratory data in the form of hypoproteinemia, high levels of urea and creatinine, elevated levels of SM and LII.

A typical laboratory sign of sepsis is a positive blood culture. Doctors who conducted a survey of six trauma centers around the world found that this symptom is considered the most consistent criterion for sepsis. The diagnosis of sepsis in the post-shock period, made on the basis of the above indicators, is very responsible, primarily because this complication of injury is accompanied by a high mortality rate of 40-60%.

Toxic shock syndrome (TSS)

Toxic shock syndrome was first described in 1978 as a severe and usually fatal infectious complication caused by a specific toxin produced by staphylococcus aureus. It occurs in gynecological diseases, burns, postoperative complications, etc. TSS manifests itself clinically in the form of delirium, significant hyperthermia, reaching 41-42 ° C, accompanied by headache, abdominal pain. Diffuse erythema of the trunk and arms and a typical tongue in the form of the so-called "white strawberry" are characteristic.

In the terminal phase, oliguria, anuria develops, sometimes the syndrome of disseminated intravascular coagulation with hemorrhages in the internal organs joins. The most dangerous and typical is cerebral hemorrhage. The toxin that causes these phenomena is found in staphylococcal filtrates in approximately 90% of cases and is called toxic shock syndrome toxin. Toxin lesions occur only in those people who are unable to develop the appropriate antibodies. This unresponsiveness occurs in approximately 5% of healthy people, apparently only people with a weak immune response to staphylococcus aureus become ill. With the progression of the process, anuria appears and a fatal outcome quickly occurs.

Diagnosis of intoxication of the body

To determine the severity of intoxication in shock trauma, various methods of laboratory analysis are used. Many of them are widely known, others are less commonly used. However, from the numerous arsenal of methods, it is still difficult to single out one that would be specific for intoxication. Below are the methods of laboratory diagnostics, which are the most informative in determining intoxication in victims with traumatic shock.

Leukocyte index of intoxication (LII)

Proposed in 1941 by Ya. Ya. Kalf-Kalif and calculated as follows:

LII \u003d (4Mi + ZYu2P + S) (Pl +1) / (L + Mo) (E +1)

where Mi - myelocytes, Yu - young, P - stab leukocytes, C - segmented leukocytes, Pl - plasma cells, L - lymphocytes, Mo - monocytes; E - eosinophils. The number of these cells is taken as a percentage.

The meaning of the indicator is to take into account the cellular response to the toxin. The normal value of the LII indicator is 1.0; during intoxication in victims with shock trauma, it increases by 3-10 times.

The level of medium molecules (SM) is determined colorimetrically according to N. I. Gabrielyan et al. (1985). Take 1 ml of blood serum, treat with 10% trichloroacetic acid solution and centrifuge at a speed of 3000 rpm. Then take 0.5 ml of the sedimentary liquid and 4.5 ml of distilled water and measure on a spectrophotometer. The SM indicator is informative in assessing the degree of intoxication, it is considered its marker. The normal value of the level of SM is 0.200-0.240 cu. units With an average degree of intoxication, the level of SM = 0.250-0.500 cu. units, with severe - over 0.500 units. units

Determination of creatinine in blood serum. Of the existing methods for determining serum creatinine, the F. V. Pilsen, V. Boris method is currently more often used. The principle of the method is that in an alkaline environment, picric acid reacts with creatinine to form an orange-red color, the intensity of which is measured photometrically. The determination is made after deproteinization.

Creatinine (µmol/L) = 177 A/B

where A is the optical density of the sample, B is the optical density of the reference solution. Normally, the level of creatinine in the blood serum averages 110.5 ± 2.9 µmol/l.

Determination of blood filtration pressure (FDC)

The principle of the technique proposed by R. L. Swank (1961) is to measure the maximum level of blood pressure, which ensures a constant volumetric flow rate of blood through a calibrated membrane. The method modified by N.K. Razumova (1990) is as follows: 2 ml of blood with heparin (at the rate of 0.02 ml of heparin per 1 ml of blood) is mixed and the filtration pressure in saline and in blood is determined on an apparatus with a roller pump. FDC is calculated as the difference between the filtration pressures of blood and solution in mm Hg. Art. The normal FDC value for human donated heparinized blood is on average 24.6 mm Hg. Art.

The determination of the number of floating particles in the blood plasma (according to the method of N. K. Razumova, 1990) is carried out as follows: blood is taken in an amount of 1 ml into a fat-free test tube containing 0.02 ml of heparin and centrifuged at 1500 rpm for three minutes, then the resulting plasma is centrifuged at 1500 rpm for three minutes. For analysis, take 160 μl of plasma and dilute in a ratio of 1: 125 with saline. The resulting suspension is analyzed on a celloscope. The number of particles in 1 µl is calculated by the formula:

The degree of hemolysis of blood

A severe injury is accompanied by the destruction of erythrocytes, the stroma of which is a source of intoxication. For analysis, take blood with any anticoagulant. Centrifuge for 10 minutes at 1500-2000 rpm. Separate the plasma and centrifuge at 8000 rpm. Measure 4.0 ml of acetate buffer into a test tube; 2.0 ml hydrogen peroxide; 2.0 ml benzidine solution and 0.04 ml test plasma. The mixture is prepared immediately before analysis. It is stirred and left to stand for 3 minutes. Then photometrically in a cuvette 1 cm against the compensation solution with a red light filter. Measure 4-5 times and record the maximum readings. Compensation solution: acetate buffer - 6.0 ml; hydrogen peroxide - 3.0 ml; benzidine solution - 3.0 ml; physiological solution - 0.06 ml.

The normal content of free hemoglobin is 18.5 mg%, in victims with shock trauma and intoxication, its content increases to 39.0 mg%.

Determination of peroxide compounds (diene conjugates, malondialdehyde - MDA). Due to their damaging effect on tissues, peroxide compounds formed during shock trauma are a serious source of intoxication. For their determination, 1.0 ml of bidistilled water and 1.5 ml of chilled 10% trichloroacetic acid are added to 0.5 ml of plasma. Samples are mixed and centrifuged for 10 min at 6000 rpm. 2.0 ml of the supernatant liquid is taken into test tubes with thin sections and the pH of each experimental and blank sample is adjusted to two with a 5% NaOH solution. The blank contains 1.0 ml of water and 1.0 ml of trichloroacetic acid.

Ex tempore prepare a 0.6% solution of 2-thiobarbituric acid in bidistilled water and add 1.0 ml of this solution to all samples. The test tubes are closed with ground stoppers and placed in a boiling water bath for 10 min. After cooling, the samples are immediately photometered on a spectrophotometer (532 nm, cuvette 1 cm, against control). The calculation is made according to the formula

C \u003d E 3 1.5 / e 0.5 \u003d E 57.7 nmol / ml,

where C is the concentration of MDA, normally the concentration of MDA is 13.06 nmol/ml, in shock - 22.7 nmol/ml; E - sample extinction; e is the coefficient of molar extinction of the trimetine complex; 3 - sample volume; 1.5 - dilution of the supernatant; 0.5 - the amount of serum (plasma) taken for analysis, ml.

Determination of the index of intoxication (II). The possibility of an integral assessment of the severity of intoxication based on several indicators of protein catabolism has almost never been used, primarily because it remained unclear how to determine the contribution of each of the indicators in determining the severity of toxicosis. The doctors attempted to rank the alleged signs of intoxication depending on the real consequences of the injury and its complications. Denoting the life expectancy in days of patients with severe intoxication by the index (-T), and the duration of their stay in the hospital by the index (+T), it turned out to be possible then to establish correlations between the indicators that claim to be criteria for the severity of intoxication in order to determine their contribution in the development of intoxication and its outcome.

Treatment of intoxication of the body

The analysis of the correlation matrix, carried out during the development of the prognostic model, showed that of all indicators of intoxication, this indicator has the maximum correlation with the outcome, the highest values ​​of AI were observed in dead patients. The convenience of its use lies in the fact that it can be a universal sign in determining indications for extracorporeal detoxification methods. The most effective detoxification measure is the removal of crushed tissues. If the upper or lower limbs are crushed, then we are talking about the primary surgical treatment of the wound with the maximum excision of the destroyed tissues, or even amputation, which is performed on an emergency basis. If it is impossible to excise crushed tissues, a complex of local detoxification measures is performed, including surgical treatment of wounds and the use of sorbents. With festering wounds, which are often the primary source of intoxication, detoxification therapy also begins with a local effect on the focus - secondary surgical treatment. A feature of this treatment is that the wounds, as in the primary surgical treatment, are not sutured after it is performed and are widely drained. If necessary, flow drainage is used using various bactericidal solutions. The most effective is the use of a 1% aqueous solution of dioxidine with the addition of broad-spectrum antibiotics. In case of insufficient evacuation of the contents from the wound, drainage with active aspiration is used.

In recent years, sorbents applied locally have been widely used. Activated charcoal is applied to the wound in the form of a powder, which is removed after a few hours, and the procedure is repeated again.

More promising is the local use of membrane devices that provide a regulated process of introducing antiseptics and analgesics into the wound and removing toxins.

It's important to know!

From a general point of view, the concept of "endogenous intoxication" (endotoxicosis) refers to a pathological condition (syndrome) that develops in various diseases due to the accumulation of various toxicants of endogenous origin in the body when the function of the natural biological detoxification system is insufficient.

Intoxication of the body is the poisoning of living tissues with harmful substances. Due to the fact that with an excessive dose of toxic substances a lethal outcome is possible, immediate medical attention is necessary. Treatment of intoxication of the body begins with measures to stop the access of toxic components.

There are exogenous and endogenous intoxication. In the first case, toxins enter the internal systems from the outside. In the second, metabolic products are produced by the body itself. Endogenous intoxication usually occurs against the background of some inflammatory process (for example, peritonitis, extensive burns, acute pancreatitis, chronic constipation).

Signs of poisoning appear depending on the type of toxin, the degree of damage to the body, the presence of susceptible receptors and the intensity of the immune system response. The main symptoms of intoxication:

• headache, joint and muscle pain;
• increased body temperature;
• diarrhea, vomiting, other disorders of the gastrointestinal tract;
• fainting, coma (in difficult cases);
• feeling very tired, drowsiness;
• dysfunction in the liver and other organs.

These disorders characterize acute intoxication. Chronic intoxication is manifested by other signs:

• chronic fatigue;
• increased irritability, depression, regular headaches;
• state of drowsiness or, conversely, insomnia;
• change in body weight.

These symptoms often occur after insufficiently competent treatment of acute intoxication or as a result of regular self-poisoning of the body, when the mechanisms of self-purification are violated. In the second case, skin rashes (furunculosis, acne, dermatitis), a decrease in immune defense are additionally observed, which leads to the frequent development of bacterial and viral infections.

The causes of poisoning are different:

Separately, it is worth noting the intoxication that develops during pregnancy. The processes occurring in the body of a woman during this period, changes in the tissues of the uterus often lead to toxicosis. Excellent results in the fight against such disorders are demonstrated by decoctions of medicinal herbs (chamomile, mint, rosehip, tansy), as well as folic acid. Before treating the pathology on your own, you need to seek advice from a gynecologist. Before taking medications, you need to make sure that there are no contraindications.

Treatment for poisoning with toxins

The need to consult a specialist doctor is determined individually in each case. If the pathological changes are large-scale and are accompanied by symptoms such as a significant increase in temperature, fainting, confusion, severe vomiting, it is urgent to call a doctor at home. The removal of the adsorbed toxin in life-threatening cases is carried out using hemodialysis (blood purification by an extrarenal method) or accelerated diuresis. The general therapy program includes the following measures:

• taking adsorbents and antidotes (if indicated);
• gastric lavage if poisoning with medications has occurred;
• increase in fluid intake;
• taking drugs Regidron and Gastrolit, which prevent dehydration, restore water and electrolyte balance and protect the damaged mucous membrane of the digestive tract.

The diet for intoxication consists of mashed vegetable soups, boiled, mashed cereals, curd soufflés and casseroles. You can eat baked fruits, crackers, drink herbal decoctions. In case of acute food poisoning, meat, dairy, sweet, sour dishes, and spices should be excluded from the diet. With minor manifestations of poisoning, it is advisable to use various means at home. Of great importance is the restoration of the functions of all systems and organs (especially with intoxication, the liver suffers).

Treatment of pathology with folk methods

In case of intoxication of the body, treatment with traditional medicine is indicated in cases of chronic or mild disease. Together with drugs and methods of traditional medicine, folk remedies increase the effectiveness of therapy and significantly speed up the healing process. To quickly get rid of the effects of intoxication, use folk recipes:

The course of procedures is designed for at least two weeks and can last several months. The recipes of folk healers are based on the use of ingredients of natural, natural origin. Home remedies are safe for the patient and are allowed to be used for a long time if the dosage is observed.

In the life of every person, situations arose when, for example, the use of a low-quality product resulted in a state of intoxication. Intoxication refers to the presence of toxins in the body and the resulting malfunctions in the systems. Harmful substances can come from the outside world or be formed internally. Depending on the number of harmful agents, a different level of intoxication is allocated. Everyone needs to know how to remove the intoxication of the body in order to be able to help themselves or another person.

Causes of intoxication

The ways in which hazardous components enter the human body are as follows:

• digestive tract;
• respiratory system;
• skin;
• mucous membranes.

The clinic directly depends on the type and amount of the irritant that has entered the body. An important role is played by the state of health and the pathways of penetration of toxins.

Signs of body poisoning

Poisoning can be of two types:

• acute;
• chronic.

An acute condition occurs with a one-time contact with a harmful substance, a chronic one is characterized by frequent contact with a foreign agent. In any course of intoxication, the following manifestations are distinguished, which occur in a complex or single symptoms:

• headache;
• muscle pain;
• hyperthermia;
• nausea or vomiting, both symptoms are possible at the same time;
• pain in the abdomen;
• diarrhea;
• tachycardia;
• weakness, covering with sweat;
• drop in blood pressure;
• disturbance of consciousness;
• fainting states;
• convulsions.

These manifestations are characteristic of acute poisoning. With chronic intake of toxins, headaches, weakness, irritability, sleep disturbance and depressive states are characteristic. A state of chronic fatigue develops, immunity decreases, allergic reactions of a different nature appear. You can add the following typical symptoms of chronic poisoning:

• constant nervousness;
• unpleasant odor from the human body;
• external signs of aging of the body - dull hair, flabby dry skin.

What to drip with alcohol intoxication

The clinical picture depends on the substance that caused the poisoning. Symptoms of intoxication may appear within an hour from the moment of contact with a harmful substance or after a while. It is on the timely assistance that a person's life depends in such situations. Some cases require immediate hospitalization, and attempts to provide care at home can cost the patient's life. It is strictly unacceptable to self-medicate in such cases:

• mushroom poisoning;
• alcohol poisoning;
• canned food poisoning;
• early childhood - children under three years of age are hospitalized immediately;
• pregnancy at any time;
• elderly age;
• people with chronic diseases;
• patients who are unconscious.

Types of intoxication

A large number of poisoning methods are known:

• drug and alcohol poisoning;
• poisoning with gases, acids and alkalis;
• poisoning with poisons, drugs;
• poisoning by plants and poisonous berries, mushrooms;
• food poisoning.

Principles of treatment

When the right conditions are created, toxins can leave the body, but this is not always the case. How to reduce intoxication? To restore the state of health, it is necessary to conduct a course of therapy aimed at relieving symptoms and eliminating the cause of intoxication.

We can distinguish the algorithm of rehabilitation actions:

• establish the cause of the development of poisoning;
• remove the cause;
• suppress the activity of harmful agents by antidote therapy;
• replenishment of lost fluid - drinking plenty of water;
• the use of laxatives and diuretics;
• gastric lavage;
• enema;
• oxygen therapy.

Removal of symptoms of drug intoxication

Drug intoxication is drug poisoning. This is one of the most common reasons. Small children sometimes mistake colorful pills for tasty candy and eat them. Adults violate the dosage or self-medicate, and all this becomes the cause of drug poisoning. When intoxication occurs, it is advisable to take two groups of drugs:

• adsorbents;
• rehydrants.

The first group includes such drugs:

• "Neosmectin";
• "Smekta";
• "Enterosgel";
• Lactofiltrum.

Reception of rehydrants helps to restore the water-salt balance and stop dehydration:

• "Rehydron";
• "Disol";
• "Acesol".

What medicines should be taken for poisoning?

The use of probiotics helps restore damaged intestinal microflora:

• "Bifiform";
• "Acipol";
• "Baktisubtil";
• "Smekta".

Removal of alcohol intoxication

In second place after drug intoxication is alcohol poisoning. As a result of excessive accumulation of ethanol in the human body, the mental state of the patient changes, and the work of internal organs is disrupted. Among the main symptoms are:

• severe headache;
• nausea, vomiting;
• dizziness, inability to move or even lie down;
• thirst.

Intoxication occurs not only as a result of excessive alcohol consumption. The reason may be the adoption of a surrogate - alcohol of low quality. This condition requires hospitalization. At home, before the arrival of doctors, it is recommended to give plenty of fluids, try to provoke vomiting.

Stages and methods of removing from intoxication at home

If the patient does not belong to the risk group and is not in a serious condition, you can try to remove intoxication at home. Sometimes not everyone knows how to remove intoxication and how to help the patient. The stages of treatment that reduce the manifestations of poisoning are:

• gastric lavage;
• enema;
• taking medications;
• plentiful drink;
• food restriction;
• peace.

It is advisable to start gastric lavage at the first signs of poisoning. This will help prevent toxins from being absorbed into the bloodstream and spread throughout the body.

To induce vomiting, you need to drink large amounts of salted water or non-carbonated mineral water. This reduces the manifestation of intoxication. It is strictly forbidden to wash the stomach with a concentrated solution of potassium permanganate. This can cause mucosal burns.

If there is no positive dynamics in the patient's condition, an ambulance should be called. Giving laxatives before diagnosis is not recommended. It is also inappropriate to give drugs that stop diarrhea during diarrhea. This leads to stagnation of toxic feces and increased intoxication. It is strictly forbidden to administer antibiotics or painkillers on your own.

Traditional medicine against intoxication

The secrets of traditional medicine can be used for self-treatment or used in combination with drug treatment. You should not get carried away with unverified recipes, you must remember that the wrong dosage of the herbal preparation can aggravate the condition or cause the condition to worsen. You can not be treated with an untested remedy. It is necessary to use only those recipes that have positive reviews and give a good result, here are some of them:

• viburnum decoction;
• rosehip broth;
• tincture of black currant leaves;
• a mixture of aloe and honey;
• watermelon peels;
• decoction of tansy in flowers.

With signs of intoxication, a special diet should be followed:

• drink plenty of water;
• exclude heavy food;
• do not eat by force;
• give preference to vegetables.

Intoxication of the body is common, and one should be theoretically savvy in matters of exit from the pathological state. It is necessary to be able to provide first aid, but it should be remembered that the state of poisoning requires the supervision of a doctor.