B.B. YATSINYUK, A.A. SOKOLOVA, P.P. GAVRIKOV, A.M. LAPTEV, V.V. GERMANOVICH

Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk

Contact details:

Yatsinyuk B.B. — PhD (medicine), Associate Professor, Head of the Department of Anesthesiology-Reanimatology, Emergency Medical Aid and Clinical Toxicology

Address: 40 Mira St., Russian Federation, Khanty-Mansiysk, 628011, tel.: +7 (3467) 39-34-37, e-mail: tocsboris@mail.ru

 Acute poisonings with non-opioid and analgesic antipyretics are the most frequent among other nosological groups of poisonings.

The purpose. To evaluate the incidence of acute chemical trauma caused by acetylsalicylic acid poisoning in the structure of poisoning in the territory, as well as the functional systems’ disorders in the toxigenic period of poisoning and options of pathogenic therapy depending on the severity of condition and results of diagnostic methods.

Materials and methods. Epidemiological analysis of poisoning in the territory was held according to the report form 64. In 2 groups (intermediate degree — n = 17; severe degree — n = 10) we assessed the functional system disorders to structure the intensive therapy options.

Results. The number of poisonings caused by acetylsalicylic acid in 2008–2017 did not exceed 0,84 cases per 100 thousand population. The intermediate severity group with 32,2 (6,1) mg% toxicant volume had neurotoxic effect, metabolic acidosis — рН 7,28 (0,05), НСО₃ — 19,8 (3,7) mmol/l, BE — 6,5 (3,9) mmol/l, respiratory alkalosis — раСО₂ 32,6 (2,6) mm Hg, plasma osmolarity — 302 (11,1) mmol/l and glucose level — 7,06 (0,53) mmol/l. In case of serious poisoning while plasma toxicant volume is higher than 41 мg%, neurotoxic disorders were more expressed, indicators of acid-alkaline condition — рН 7,2 (0,07), раСО₂ — 31,8 (2,8) mm Hg, НСО₃ — 18,4 (4,7) mmol/l, BE — 10,5 (3,9) mmol/l, lactate — 3,6 (0,7) mmol/l, aniongape > 18 m.e/l, hyperglycemia was observed — 8,78 (5,11) mmol/l and plasma osmolarity changed — 309 (8,0) mmol/l. In case of intermediate and severe poisoning, intensive therapy should be aimed for removing the unabsorbed poison: washing of stomach, enterosorption, intestinal lavage, toxicant and its metabolites elimination (completion of OTsK — volume of blood circulation), forced diuresis, acid-alkaline balance correction (1–2 mmol/kg while toxigenic period with maintaining 7,0–7,5 urine рН gap. When using therapy options, it is necessary to consider possible development of acute renal and liver failure, coagulopathies and change of glucose level in blood.

Conclusions. Definition of acute poisoning severity on the basis of violations of functional systems is the key factor in prescribing the pathogenetic therapy.

Key words: acute chemical trauma, acetylsalicylic acid, symptoms of poisoning.

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