A case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock (clinical observation)

Abstract

Introduction. The article considers a case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock.
 Clinical observation. An episode of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree (baclofen, (4-amino-3-(4-chlorophenyl) is presented-butyric acid – 
 ethylglucuronide >2000 mg/ml), methadone 83 mg/ml, methylenedioxypyrovaleron 57 ng/ml, complicated by the development of exotoxic shock in a 32-year-old patient. The clinical picture of acute poisoning was manifested by depression of consciousness to the level of coma II, acute respiratory failure, mixed respiratory and metabolic acidosis (pH 7.18; partial pressure of carbon dioxide 64.0 mmHg, lactic acidosis 
 up to 5 mmol/l), swelling of the brain, exotoxic shock (BP – 60/20 mmHg, heart rate – 110 beats per minute).
 Intensive therapy included: respiratory, infusion, detoxification, anticoagulation, antibacterial therapy, correction of acid-base state disorders, water-electrolyte balance, nutritional support, normalization 
 of metabolic disorders through the use of a substrate antihypoxant. The calculation of the required 
 amount of sodium bicarbonate was carried out according to the Mellengaard-Astrup formula: the amount of mmol of sodium bicarbonate is equal to the product of VE • body weight in kg • 0.3. According 
 to the calculation, the amount of required bicarbonate was 195 mmol, that is, in terms of 5% bicarbonate solution – 195 ml.
 Conclusion. As a result of basic resuscitation care in the form of artificial lung ventilation, correction of mixed respiratory and metabolic acidosis by using sodium bicarbonate, infusion therapy to correct hypovolemia, ensuring optimal perfusion of organs and tissues, elimination of key links of hypoxia by using cytoflavin, improvement of rheological properties of blood and symptomatic therapy allowed for a favorable outcome of severe poisoning with a mixture of narcotic and psychoactive substances complicated by the development of exotoxic shock.