Acute poisoning with ethanol

Description:

ALCOHOLIC POISONING ACUTE
The acute alcoholic poisoning is usually connected (ethanol) with reception of alcohol or the drinks containing more than 12% of alcohol. Deadly concentration of ethanol in blood - 0,5-0,8 g/dl, a lethal single dose - 4-12 g/kg (about 300 ml of 96% of ethanol); however this indicator is various at different patients and often depends on the acquired tolerance to alcohol. Acute alcoholic poisonings are most eurysynusic in the countries of northern and middle latitudes.

Frequency. 25% of all acute poisonings. More than 60% of all fatal poisonings are caused by alcohol. The prevailing floor - men's. Risk factors Alcoholism (about 90% hospitalized with acute alcoholic poisonings are sick with alcoholism) the Use of alcoholic drinks on an empty stomach (food masses in a stomach slows down alcohol absorption) Alcoholic drinks with a strength up to 30% are soaked up quicker.

Symptoms of Acute poisoning with ethanol:

Emotional lability. Lack of coordination of movements. Face reddening. Nausea and vomiting. Respiratory depression. Consciousness disturbance.

The alcoholic coma develops at concentration of ethanol in blood of 0,3-0,7 mg of %. The symptomatology of an alcoholic coma (especially deep) is not specific and represents option of a narcotic coma.

Superficial coma: lack of speech contact, loss of consciousness, decrease in corneal, pupillary reflexes, sharp oppression of painful sensitivity. Neurologic symptomatology - decrease or increase in a muscle tone and tendon jerks (often there are a lockjaw of chewing muscles, meningeal symptoms, mio-.fibrillyation usually in a thorax and a neck); pathological eye symptoms (the floating movements of eyeglobes, an anisocoria) are changeable, pupils are usually narrowed (miosis), at increase of disorders of breath extend. Usually allocate 2 periods of a superficial alcoholic coma 1 period: the prick or pressure in painful points of a trifacial, steam inhalation of liquid ammonia are followed by expansion of pupils, mimic reaction, the protective movements of hands the 2nd period: in response to similar irritations there is only a weak hyper tone of hands and legs, miofibrillyation; the pupillary test is changeable.

Deep coma: full loss of painful sensitivity, absence or sharp decrease in corneal, pupillary, tendon jerks, muscular atony, decrease in body temperature.

Disturbances of external respiration - the main reason for death at a pre-hospital stage in the absence of medical care of Obturatsionno-aspiratsionnye of disturbance (retraction of language, hypersalivation and a bronchorrhea, aspiration of emetic masses), a stridor, a tachypnea, a Crocq's disease, swelling of cervical veins, are possible large-bubbling rattles in lungs, expansion of pupils Disturbance of breath on the central type arises only at a deep alcoholic coma.

Disturbances of the Tachycardia functions CCC - the most constant clinical symptom At a deep coma of the ABP sharply decreases Hypercoagulation with acidosis and the general hypothermia lead to disorders of microcirculation.

Methods of research EEG ECG (decrease in a segment of S-T, negative tooth of T, premature ventricular contraction; at an alcoholic cardiomyopathy permanent disturbances of a rhythm and conductivity are possible). The microdiffusion test and gas-liquid chromatography - tests for presence of ethanol at blood.

Differential diagnosis. Craniocereberal injury. Acute disorder of cerebral circulation. Poisonings with false substitutes of alcohol (chlorinated hydrocarbons, methanol, ethylene glycol). Poisonings with somnolent drugs, drugs and tranquilizers. Hypoglycemic coma.

Reasons of Acute poisoning with ethanol:

Ethanol easily gets through fabric membranes, is quickly soaked up in a stomach (20%) and a small bowel (80%); on average in 1,5 h its concentration in blood reaches the maximum level

Ethanol has the psychotropic (narcotic) effect accompanied with suppression of processes of excitement in TsNS that is caused by change of metabolism of neurons, dysfunction of mediator systems, decrease in utilization of oxygen Development of a metabolic acidosis (accumulation of acid products of its biotransformation).

Treatment of Acute poisoning with ethanol:

Hospitalization at a heavy drunkenness (a coma, disturbances of breath and blood circulation) in the toxicological Ensuring Adequate Ventilation of the Lungs center. The oral cavity toilet, fixing of language tongue forceps At a superficial coma enter an air duct, at a deep coma the intubation with the subsequent suction of slime and emetic masses from upper respiratory tracts is shown. At disturbance of breath on the central type - IVL after a trachea intubation. The gastric lavage via the probe is carried out after ensuring adequate ventilation of the lungs. Intensive maintenance therapy: the actions directed to the prevention of a hypoglycemia and ketoacidosis. Artificial diuresis. A hemodialysis (according to indications) At the expressed obturatsionno-aspiration syndrome - the emergency bronkhoskopiya of a dignity-tsionnaya; for permission of atelectases - a postural drainage Treatment of complications. Lack of positive dynamics of a condition of the patient during 3 h against the background of the carried-out therapy testifies to not recognizable complications (ChMT, atelectases of lungs, etc.) or the wrong diagnosis.

Medicinal therapy.
Atropine of 1-2 ml of 0,1% of solution of l / to for decrease in hypersalivation and a bronchorrhea.

Antishock therapy (at heavy hemodynamic frustration) Plasma substitutes (Polyglucinum, Haemodesum, реополиглюкин) in/in kapelno 5% solution of glucose, 0,9% NaCl solution in/in kapelno. Analeptics (introduction of Bemegridum or high doses of analeptics contraindicated because of danger of development of a convulsive syndrome and obturatsionny forms of disturbances of breath) Prednisolonum 60-100mg in/in kapelno at persistent arterial hypotension.

For correction of a metabolic acidosis - 600-1000 ml of 4% of solution of Natrii hydrocarbonas in/in kapelno.

For acceleration of oxidation of alcohol and normalization of exchange processes - glucose (40-60 ml of 40% of solution with insulin) in/in; thiamin, pyridoxine, nicotinic and ascorbic acids.

At development of complications - antibiotics.