Poisoning narcotic analgetics
Contents:
Description:
Acute poisonings with narcotic analgetics (opioids) take the second place after alcoholic poisonings and its substitutes. Drugs of this group (heroin, codeine, Meperidinum, methadone, morphine, opium, propok-sifen, Omnoponum, Promedolum, dionine, Thecodinum, Fenadonum) usually designate the general term "drugs".
• Narcotic analgetics are quickly soaked up from a GIT.
• The detoxication happens in a liver by conjugation to glucuronic acid (90%), 75% are removed with urine in the first days in the form of conjugates.
Symptoms of Poisoning with narcotic analgetics:
I stage (slight poisoning) of poisoning with narcotic analgetics.
- Drug intoxication, confusion of consciousness, devocalization, soporous deep sleep; the contact with patients is possible.
- Hyperemia of integuments.
- Miosis, slackness or lack of reaction of pupils to light.
- Breath disturbance even at consciousness preservation (oppression of a respiratory center of a myelencephalon).
- Increase or safety of tendon and periosteal jerks.
- Decrease or lack of reaction to pain stimulation, thermal control disturbance.
The II stage — coma poisonings with narcotic analgetics.
- Loss of consciousness.
- Miosis (85%).
- Decrease in a reakshchiya on pain stimulations (68%).
- Tsentrogenny disturbances of breath (100%).
- The expressed decrease in the ABP (60%).
- A lockjaw of masseters, increase in a muscle tone on spastic type, an opisthotonos, convulsive attacks.
III stage (serious poisoning) of poisoning with narcotic analgetics.
- Disturbances of breath up to an apnoea.
- Sharp cyanosis of skin and mucous membranes.
- Expansion of pupils.
- Bradycardia, collapse, hypothermia.
Reasons of Poisoning with narcotic analgetics:
Lethal dose of morphine at intake of 0,5 — 1 g, at in introduction 0,2g. Deadly concentration in blood of 0,14 mg/l.
Pathogenic effects: psychotropic; neurotoxic, caused by the oppressing influence of narcotic analgetics on thalamic areas; decrease in excitability of the respiratory and tussive centers, excitement of the center of a vagus nerve.
Treatment of Poisoning with narcotic analgetics:
Hospitalization: at disturbances of breath and consciousness in the toxicological center; at a stage of I in a narcological hospital.
Pathogenetic therapy.
- Ensuring adequate ventilation of the lungs (up to IVL), an oxygenotherapy.
- A repeated gastric lavage via the probe (even at parenteral administration of morphine), absorbent carbon, salt laxative (vomitives are contraindicated).
- Artificial diuresis.
- Normalization of KShchR.
- Detoksikatsionny hemosorption, peritoneal dialysis.
- Warming of a body.
Symptomatic therapy of poisoning with narcotic analgetics: elimination of heavy respiratory and hemodynamic frustration, stopping of a convulsive syndrome, elimination of complications.
Specific medicinal (antidotal) therapy of poisoning with narcotic analgetics — Naloxonum from 5 mkg/kg to 2-20 mg, in need of introduction is repeated by 10-20 times; Nalorfinum.
Age features of poisoning with narcotic analgetics. All drugs are especially toxic for children of younger age. A lethal dose for children up to 3 years: codeine — 400 mg, Fenadonum — 40 mg, heroin — 20 mg.
