Сучасні Підходи До Комплексної Діагностики Та Лікування Пацієнтів Із Комбінованими Отруєннями Метадоном В Умовах Спеціалізованого Токсикологічного Центру
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RESUME. Despite the fact that opioids do not have direct nephrotoxicity, a significant overdose, or their combination with alcohol and other psychotropic substances, contributes to the development of critical changes in many organs and systems of the body, which leads, in particular, to acute kidney injury (AKI). Aim. Using comparative analysis and the Kaplan-Meier method, to investigate the survival rates of patients with opioid drug poisoning complicated by acute respiratory distress syndrome treated with hemodialysis. Materials and Methods. A cohort retrospective analysis of the medical data of 128 patients (107 men, 21 women) aged 18 to 39 years who received treatment in the intensive care and extracorporeal detoxification department of the "Kyiv City Emergency Hospital" in the period 2017–2021 with a diagnosis of "Acute drug poisoning" (МКХ-10:Т40.0-Т40.3), complicated by the development of acute renal failure. Statistical analysis of the study results was performed using the Kaplan-Meier survival estimate; p≤0.05; the statistical analysis application package from Microsoft Excel 2019 was used. Results. Kaplan-Meier graphs indicated that patients with AKI due to morphine, heroin, and methadone poisoning have a statistically significant difference in survival rates (p < 0.05). The highest survival rates were shown by patients with morphine poisoning (100 %), the lowest were in groups with methadone (82.7 %) and heroin poisoning (48.3 %). Kaplan-Meier curves showed that all deaths occurred within 3–18 days of starting treatment, with most deaths (90 %) occurring within 3–12 days. Cumulative survival rates among patients with methadone-induced AKI stratified by blood alcohol content showed that among patients with methadone poisoning where alcohol was not detected, the survival rate was 100 %, and among patients with combined methadone and alcohol poisoning it was 75.2 %. Conclusions. Despite the similarity of the clinical picture in poisoning with natural and synthetic opioids (opioid syndrome), the causes of development of AKI and its course differ in patients with poisoning by different groups of drugs. Survival rates among patients with methadone poisoning are adversely affected by the presence of alcohol in the blood. Key Words: combined drug poisoning, renal failure.
RESUME. Despite the fact that opioids do not have direct nephrotoxicity, a significant overdose, or their combination with alcohol and other psychotropic substances, contributes to the development of critical changes in many organs and systems of the body, which leads, in particular, to acute kidney injury (AKI). Aim. Using comparative analysis and the Kaplan-Meier method, to investigate the survival rates of patients with opioid drug poisoning complicated by acute respiratory distress syndrome treated with hemodialysis. Materials and Methods. A cohort retrospective analysis of the medical data of 128 patients (107 men, 21 women) aged 18 to 39 years who received treatment in the intensive care and extracorporeal detoxification department of the "Kyiv City Emergency Hospital" in the period 2017–2021 with a diagnosis of "Acute drug poisoning" (МКХ-10:Т40.0-Т40.3), complicated by the development of acute renal failure. Statistical analysis of the study results was performed using the Kaplan-Meier survival estimate; p≤0.05; the statistical analysis application package from Microsoft Excel 2019 was used. Results. Kaplan-Meier graphs indicated that patients with AKI due to morphine, heroin, and methadone poisoning have a statistically significant difference in survival rates (p < 0.05). The highest survival rates were shown by patients with morphine poisoning (100 %), the lowest were in groups with methadone (82.7 %) and heroin poisoning (48.3 %). Kaplan-Meier curves showed that all deaths occurred within 3–18 days of starting treatment, with most deaths (90 %) occurring within 3–12 days. Cumulative survival rates among patients with methadone-induced AKI stratified by blood alcohol content showed that among patients with methadone poisoning where alcohol was not detected, the survival rate was 100 %, and among patients with combined methadone and alcohol poisoning it was 75.2 %. Conclusions. Despite the similarity of the clinical picture in poisoning with natural and synthetic opioids (opioid syndrome), the causes of development of AKI and its course differ in patients with poisoning by different groups of drugs. Survival rates among patients with methadone poisoning are adversely affected by the presence of alcohol in the blood. Key Words: combined drug poisoning, renal failure.
Practical aspects of using extracorporal detoxification methods in the treatment of acute chemical poisoning
Abstract. The structure of xenobiotics that cause poisoning and the need for hospitalization is constantly changing. Today, psychotropic and narcotic substances and their precursors have become the main cause of severe poisonings that require emergency medical care. At the same time, another problem is the combined use of narcotic substances and alcohol, which often causes multiorgan dysfunction and prompts doctors to search for new treatment approaches, using traditional methods of afferent and efferent therapy in combination with modern extracorporeal detoxification technologies. Aim. Study of the peculiarities of the use of extracorporeal detoxification methods in the treatment of patients with acute chemical poisoning, which are associated with the change in the structure of poisons for 1990-2020. Materials and Methods. A cohort retrospective analysis of 1,685 charts of hospitalized patients with acute poisoning (Form No. 003/0) and 5,025 protocols of artificial detoxification procedures was conducted. Data from the reports of the Toxicological department and the Intensive care and extracorporeal detoxification unit of the Kyiv City Clinical Emergency Medical Center (hereinafter referred to as the Toxicological Center) for the period 1990-2020, with information on the structure of medical technologies (membrane, centrifugal, sorption and other) and the number of artificial detoxification methods used during the study period. Results. On average, the Kyiv Toxicological Center provides medical care to about 2,500 adult patients with chemical poisonings per year, of which about 1,500 patients will receive assistance in the Intensive care and extracorporeal detoxification unit. About 64,000 patients were treated in the period 1990-2020. It was established that the structure of acute poisonings has undergone significant changes: the number of poisonings by pesticides (organophosphorus substances, carbamates, and pyrethroids), technical fluids and solvents (ethylene glycol, dichloroethane, hydrogen tetrachloride, and methanol), metals (lead, mercury), corrosive substances (acids, alkalis). At the same time, a significant number of poisonings with alcohol and its surrogates, plant toxins and mushrooms, and household chemicals remained. The share of domestic, suicidal and criminal drug poisonings increased. However, after 2015, the number of poisonings by drugs, psychotropic substances (methadone, heroin, synthetic opioids) and their precursors, including in combination with benzodiazepines, meth- and amphetamine, cocaine and ethanol, has increased rapidly. In general, the part of drug poisonings has increased 3.5 times over the past 30 years. In accordance with the change in the structure of acute poisoning, the structure of extracorporeal detoxification technologies has also gradually undergone changes. The annual number of sorption technologies (hemosorption, plasmasorption) decreased. At the same time, there was an increase in the number of centrifuge technologies and membrane plasmapheresis. Significant changes have taken place in the direction of the application of blood oxygenation methods: the use of HBO in the treatment of acute poisoning has almost stopped, but the number of ozone therapy procedures and ultraviolet irradiation of the blood is increasing. During the study period, membrane technologies (hemodialysis, ultrafiltration, hemoperfusion) are the most common in the treatment of poisoning. Conclusions. The structure of toxic substances that cause household poisoning has undergone significant changes over the past 30 years: the number of poisonings by narcotic, psychotropic substances, medicines and alcohol has increased. There was a need to improve the existing approaches to the application of extracorporeal detoxification methods, in particular, a promising direction of research is the study of the effectiveness of various technologies for removing toxicants from the blood in case of poisoning with "new" narcotic, psychotropic substances and their precursors. The clinical effectiveness of hemodialysis, plasmapheresis, ozone therapy and ultraviolet irradiation of blood and their combination in the program of complex treatment of poisoning in adults are demonstrated. Key Words: acute poisoning, drugs, extracorporeal detoxification.
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