1. The general toxic effect of alcohol is characterized by the following metabolic changes:

Decreased gluconeogenesis in the liver and impaired glucose oxidation in tissues

- increased gluconeogenesis and activation of anaerobic glycolysis in tissues

Decreased protein synthesis and development of dysproteinemia

The development of fatty infiltration of the liver

- increased protein anabolism and a decrease in the content of ammonia in the blood

Increased lipogenesis and the development of hypercholesterolemia

2. The toxic effect of alcohol on the nervous system is characterized by:

- inhibition of the release of catecholamines from the presynaptic structures of the hypothalamus and midbrain

Stimulation of the release of catecholamines from the presynaptic structures of the hypothalamus and midbrain

Inhibition of the synthesis of acetylcholine and its release from the presynaptic structures of the brain

- stimulation of the synthesis and release of acetylcholine from the presynaptic structures of the brain

Activation of the GABAergic system of the brain

- inhibition of the GABAergic system of the brain

Activation of the opioidergic system of the brain

- inhibition of the opioidergic system of the brain

3. Specify the changes in the main cortical nervous processes that are often observed in chronic alcohol intoxication:

Weakening of the process of internal cortical inhibition

- strengthening the process of cortical inhibition

- strengthening the process of excitation

Weakening of the excitation process

Pathological inertia of inhibition processes

- pathological inertia of the excitation process

4. Choose the correct statement:

- acetaldehyde - a product of the oxidation of ethanol, which has a much lower toxicity compared to it

Acetaldehyde (an intermediate product of the oxidation of ethanol) is the main cause of the development of toxic effects when drinking alcohol.

5. Indicate the correct answer: the cytotoxic membranotropic effect of ethanol is associated with:

- a decrease in the fluidity and permeability of cell membranes

Dysfunction of surface receptors and membrane-bound enzymes

A decrease in viscosity and an increase in the permeability of cell membranes

6. Physical dependence on ethanol in typical cases manifests itself:

Persistent irresistible craving for alcohol

- periodically arising desire to drink, which is not necessarily realized

The development of withdrawal syndrome after the cessation of many days of drinking

drinking binges

The use of alcohol in cases where it is contrary to social and ethical standards or damages a career, reputation, family relationships

Alcohol consumption, despite a high risk of exacerbation of a chronic somatic disease

- willingness to refuse to take alcoholic beverages if circumstances prevent this

7. Alcohol withdrawal syndrome is characterized by:

Tremor

Depressed mood, irritability

- increased sleepiness

Nausea, vomiting

Nightmares, insomnia

- aggravation of symptoms of autonomic disorders after taking a small dose of alcohol

Improvement after taking a small dose of alcohol

8. What signs are typical for the state of severe intoxication with narcotic substances with sedative and hypnotic effects (benzodiazepines, barbiturates):

- BP is normal or slightly elevated

Arterial hypotension

- decrease in heart rate

Increase in heart rate

Ataxia, slurred speech

Vertical and horizontal nystagmus

constricted pupils

9. What signs are typical for the state of intoxication with narcotic substances with a psychostimulating effect (cocaine, amphetamines):

Arterial hypertension, hyperthermia

- hypotension, hypothermia

- decrease in heart rate

Increased heart rate and breathing

- ataxia, slurred speech

Excited state, fussiness, restlessness

- prone to stereotyped movements

dilated pupils

10. What signs are typical for the state of intoxication with drugs of the opium group:

BP is normal or slightly elevated

- arterial hypotension

Decreased frequency and volume of respiratory movements

- rapid breathing

Ataxia, slurred speech

- excited state, fussiness

+ "pupils-beads"

Reducing pain

11. Early manifestations (8-10 hours after the last dose) of opium withdrawal syndrome include:

sweating

- fever

Feelings of anxiety, restlessness

- drowsiness

- constriction of the pupils

pupil dilation

Lacrimation, rhinorrhea

stomach cramps

12. Late manifestations (1-2 days after the last dose) of opium withdrawal syndrome include:

Tremor of fingers

Piloerection ("goosebumps"), fever

Vomiting, diarrhea

- bradycardia

tachycardia

Muscle spasms and pain

- decreased muscle tone

Irritability, impulsive behavior

13. The formation of a pathological craving for alcohol is presumably associated with the action of the following mechanisms:

Changes in the lipid composition of the neuronal membrane, leading to a decrease in its viscous-elastic properties

Influence of condensation products of acetaldehyde and biogenic amines on the centers of regulation of "motivational behavior"

- a decrease in the activity of aldehyde dehydrogenase in liver cells

Acceleration of the circulation of the neurotransmitter dopamine in the structures of the hippocampus, leading to its relative excess

- restructuring of metabolic processes in brain neurons in such a way that ethanol becomes an important energy substrate

- abstaining from alcohol

14. In chronic alcohol abuse, the following pathological changes are found in the blood:

Increase in the average diameter of erythrocytes

- hypermagnesemia

- high levels of androgens

Increased activity of aminotransferases (AST and ALT)

Appearance of acetaldehyde-modified albumin and Hb

– increase in the content of vitamins E and A

Increasing acetate levels

Increasing the content of CT

15. In the pathogenesis of alcoholic hepatitis, the following processes are of great importance:

Formation of a covalent bond between the product of ethanol oxidation by acetaldehyde and the cytoskeletal protein tubulin

- inhibition of collagen synthesis

The production of antibodies against acetaldehyde-modified proteins

Impaired ability of the liver to secrete VLDL

— activation of the microsomal ethanol-oxidizing system

Activation of macrophages (von Kupffer cells) in the liver tissue and their release of inflammatory mediators

16. Specify the most frequent somatic consequences of long-term alcohol abuse:

Chronic hepatitis, cirrhosis of the liver

Cardiomyodystrophy

- atherosclerosis of cerebral vessels

Chronic pancreatitis

Polyneuritis

– arthritis

Chronic gastritis

– anemia

17. The following factors contribute to the development of somatic pathology with prolonged alcohol abuse:

Drunken nature of alcohol use (alternating periods of drunkenness and abstinence from alcohol)

- continuous use of alcohol

Phenotype characterized by the presence of a highly active form of alcohol dehydrogenase

- a phenotype characterized by the presence of an inactive form of alcohol dehydrogenase

- a phenotype characterized by the presence of a highly active form of aldehyde dehydrogenase

Phenotype characterized by the presence of an inactive form of aldehyde dehydrogenase

Deficiency of thiamine (vitamin B1) in food

- deficiency of ascorbic acid in food

18. Alcoholism:

- a form of addiction

Substance abuse

- bad habit

- psychosomatic illness

- congenital mental illness

19. Macrocytosis of erythrocytes and leukopenia in patients with alcoholism are caused by:

Toxic effects of ethanol on bone marrow stem cells

folic acid deficiency

- iron deficiency

- increased destruction of erythrocytes and leukocytes in the blood with severe alcohol intoxication

- thiamine deficiency (vitamin B1)

Vitamin B12 malabsorption

20. In the pathogenesis of alcoholic cardiomyopathy, an important role is played by:

Induction of the synthesis of the peroxide-producing enzyme acyl-CoA oxidase in cardiomyocytes

Activation of LPO processes in myocardial cells

Direct toxic effect of acetaldehyde on cardiomyocytes

- accumulation of excess glycogen in cardiomyocytes

- excessive formation of CTs in the liver and their increased capture by cardiomyocytes

Increased release of catecholamines in the sympathetic nerve endings of the myocardium

- mutations in the genome of cardiomyocytes under the influence of acetaldehyde

Toxic effect of catecholamine oxidation products on myocardial cells

THE TOXIC EFFECT OF ALCOHOL

By the nature of the action, alcohols are drugs. It was found that with an increase in the number of carbon atoms, the strength of the narcotic effect increases.

Etiology and pathogenesis

When poisoning with alcohols in the urine, their concentration is low. Alcohols are excreted with exhaled air, the content in the tissues depends on the rate of alcohol oxidation. Methyl alcohol oxidizes more slowly, ethyl alcohol - faster. The toxicity of alcohol depends on the structural formula, polyhydric alcohols are low toxic (with the exception of ethylene glycol, which decomposes into a toxic substance - oxalic acid).

Clinic

Consciousness and sensitivity in alcohol intoxication are absent. There is hyperemia of the skin of the face, the skin is cold, acrocyanosis, a decrease in body temperature. Breathing shallow, irregular. Decreased corneal reflex, scleral injection, pupil dilation. There is a persistent smell of alcohol from the mouth. The pressure is lowered, the pulse is frequent, weak filling.

Diagnostics

On auscultation, heart sounds are muffled, non-rhythmic (sometimes a gallop rhythm is heard). Vomiting, involuntary urination and defecation often begin. As a complication, pulmonary edema develops. To reliably diagnose alcohol poisoning, it is necessary to determine the level of alcohol in the blood, the smell of alcohol. If the victim, in addition to alcohol intoxication, has any other diseases, then the diagnosis is difficult.

Treatment

Gastric lavage during the first hours with water at room temperature. Cleaning of the upper respiratory tract with recovery from their patency. Detoxification therapy - intravenous infusion of a glucose solution with insulin (this causes a decrease in the concentration of alcohol in the blood). symptomatic treatment.

TOXIC EFFECTS OF ALCOHOL 2-PROPANOL- the negative toxic effect of alcohol on the body.

Etiology and pathogenesis

The pathogenesis is similar to alcohol poisoning.

Clinic

Very similar to ethyl alcohol poisoning, but more severe. Taking propanol inside causes photophobia, lacrimation, dizziness, headache, weakening of cardiac activity. Dyspeptic disorders develop (diarrhea, vomiting). In some patients, hearing deteriorates, visual acuity decreases. First aid and treatment are similar to those for ethyl alcohol poisoning. In severe poisoning, a coma quickly develops, and then death occurs due to respiratory arrest.

TOXIC EFFECTS OF ALCOHOL METHANOL- the negative toxic effect of alcohol on the body.

Etiology and pathogenesis

Poisoning occurs when methyl alcohol is taken orally. According to the narcotic effect, this alcohol is inferior to ethyl alcohol, but it is much superior in toxicity, as it decomposes into toxic decay products: formic acid and formaldehyde. These substances primarily affect the central nervous system. As a result, blood pressure first rises and then falls until it collapses. Metabolic acidosis develops.

Clinic

The degree of damage depends on the amount of poison taken. The picture of methanol poisoning is characterized by the absence or mild intoxication. When taking 200-300 ml of alcohol at a time, intoxication appears almost instantly. The person is stunned, coma develops very quickly. Reflexes are lowered, involuntary urination is noted. There is a violation of breathing: at first it is noisy, rare, deep, then - superficial and arrhythmic. Nausea and vomiting appear. Very early on, such a visual impairment develops as "flies" before the eyes, blurred vision. Visual impairment can progress to blindness. Arterial pressure and body temperature decrease, pupils dilate, poorly react to light. The patient is excited. Death comes from respiratory failure.

Treatment

Gastric lavage, saline laxative. Hemodialysis with stable blood pressure, peritoneal dialysis if there is unstable hemodynamics. The introduction of an antidote - a 5% solution of ethyl alcohol intravenously drip. Vitamin therapy, glucose solution with insulin.

TOXIC EFFECTS OF ALCOHOL ETHANOL- the negative toxic effect of alcohol on the body.

Etiology and pathogenesis

Ethyl alcohol has a depressing effect on the central nervous system. First of all, the cerebral cortex and subcortical formations are affected.

Clinic

The intake of alcohol in a dose that depresses the spinal cord and reflexes suppresses the activity of the respiratory center. If the concentration of alcohol in the blood reaches 0.4%, the development of coma is possible, and more than 0.6% leads to death from cardiac arrest. If the intoxication is severe, then the stage of euphoria and arousal is replaced by a deep coma. Alcohol smells from the mouth, foam on the lips. The body temperature drops, the skin is wet, cold. The pulse of weak filling, frequent, there is a drop in cardiac activity. There are convulsions.

There are 3 degrees of alcoholic coma:

1) muscle tone is increased, there is a reduction in masticatory muscles, changes in the ECG;

2) muscular hypotension develops, tendon reflexes are reduced, but pain sensitivity is preserved;

3) deep coma, muscular hypotension develops, corneal and tendon reflexes are absent.

One of the formidable complications of ethyl alcohol poisoning is respiratory failure caused by retraction of the tongue, aspiration of mucus. The second complication is the development of myoglobinuria. Often, patients develop acute renal failure.

Treatment

Often the outcome of poisoning depends on how quickly and correctly first aid is provided to the victim. It is necessary to wash the stomach with water at room temperature, suck out mucus from the oral cavity, and if there are no reflexes, intubate. The patient is on controlled breathing, receiving a sufficient amount of pure oxygen. Symptomatic treatment is aimed at restoring the functions of the cardiovascular and respiratory systems. With a decrease in pressure, mezaton is prescribed, a glucose solution and vitamins are administered intravenously. The elimination of alcohol is accelerated by the use of forced diuresis.

The history of making intoxicating drinks goes back thousands of years.

But grape wine was especially widespread in antiquity. Wine was read as a gift from the gods. The patron saint of winemaking in Greece is Dionysus, in Latin form - Bacchus.

Harmful impurities are also contained in commercial wine. Their pathophysiological effect on the body is due not only to the strength (percentage of alcohol), but also to numerous harmful impurities. One of the companions of wine is methyl alcohol. Methyl alcohol is a neurovascular poison, and its dose of 100g is lethal to humans. Even small amounts of this alcohol affect the optic nerve and retina. Sulfur dioxide is used to process wines. It destroys B vitamins. Numerous acids (tartaric, acetic, sulphurous, and others) found in wines adversely affect the digestive organs, especially the liver and pancreas.

The alcohol content ranges from 2.8% to 12% alcohol. But beer contains various substances that increase the body's sensitivity to alcohol, enhancing its absorption. Therefore, mixing beer and vodka, as a rule, leads to rapid and severe intoxication. Wormwood, hops and other additives are added to beer to give different taste and aromatic shades. These herbs have a toxic effect on the liver and kidneys, pancreas.

Pure alcohol began to be obtained in the 6th-7th centuries by the Arabs and they called it "al cogl", which means "intoxicating". The first bottle of vodka was made by the Arab Rabez in 860. What is alcohol?

This is ethyl alcohol - a highly flammable colorless liquid with a characteristic odor, related to highly effective drugs. It causes first excitation and then paralysis of the nervous system. When alcohol enters the bloodstream, it begins to interact with erythrocytes (red blood cells), which carry oxygen from the lungs, and carbon dioxide in the opposite direction. Alcohol "sticks together" erythrocytes, larger balls are formed. The size of the "balls" increases with the amount of alcohol consumed. Such a large formation is not able to move through the capillaries, a thrombus is formed (or a rupture of the walls of the capillaries - a hemorrhage), "numbness" occurs, and then the death of parts of the body and brain. This is perceived by a person as a state of intoxication. Sleep in this state is a loss of consciousness, an alcoholic coma.

There are approximately 17 billion cells in the human brain, which leaves 2% of body weight, it absorbs up to 30% of the drunk ethanol!

1 gram of ethanol penetrated into the brain kills about 200 neurons! The action of ethyl alcohol in the brain lasts 65 days!

Recovery of reversible consequences from drinking a bottle of beer (500 g), a glass of champagne (200 g), vodka (100 g) can occur with absolute sobriety within 2-3 years!

It turns out. That the hangover syndrome is a process associated with the removal from the brain of neurons that died due to lack of blood supply. The body rejects dead cells. This is associated with morning headaches. Alcohol damages the liver. Because it neutralizes 95% of alcohol. As a result, hepatitis, cirrhosis, and then liver necrosis occurs, leading to the death of the body. Alcohol is detrimental to the digestive system. A group of persons with a healthy stomach was introduced a miniature device through which it was possible to see the walls of this organ. The subjects drank 200 g of whiskey on an empty stomach. A few minutes later, redness of the mucous membrane and swelling were observed, after an hour - numerous bleeding ulcers, and after a few hours, purulent stripes appeared on the gastric mucosa. If a person drinks regularly, then there is a stomach ulcer, cancer.

Alcohol contributes to the degeneration of the gene pool. Ethanol is able to destroy genes, which leads to the birth of sick children. The death of one or three cells at the beginning of the development of the embryo may result in further underdevelopment, or even the absence of any organ. Often the children of drinking mothers and fathers are born with an alcoholic syndrome: strabismus, congenital deafness, heart defects, with a small head, reduced brain, mentally retarded, mentally ill, with severe deformities (dropsy of the brain or its absence, cleft palate, cerebral hernia, spina bifida , incomplete number of fingers, their fusion, the absence of a part of the skeleton, etc.) In adults, there is a decrease in mental abilities, weakening of memory, dementia, personality degradation.

In mental workers, after taking alcohol, their thought processes are fundamentally worsened, the speed and accuracy of calculations are reduced, as they say, the work falls out of hand.

On average in the country per year per capita (including the elderly and infants) there are 15-16 liters of "pure alcohol". By the standards of the World Health Organization, every liter drunk in excess of eight liters shortens the average life expectancy of men by a year, women by 4 months. It is alarming that over 96% of people who drink drink before the age of 15, and about a third before the age of 10.

A painful addiction to alcohol can occur in any kind of animal if they are taught to drink wine or vodka.

Typical objects of observation of the effect of alcohol on a living organism are laboratory rats and mice. By adding alcohol to water, animals become alcoholics. In the absence of an alcoholic drink, animals behave like real alcoholics: they rush around the cage, bite each other viciously. Some, after a period of excitement, limply stretch on the floor of the cell - exactly the same as a drunkard in a state of hangover. Alcoholism of animals is accompanied by changes in their sexual sphere. They have reduced sperm production, which is dominated by incapacitated spermatozoa.

Small doses of alcohol cause underdevelopment of germ cells in males and females. In young "non-drinking" animals during the experiment, the seminiferous tubules increased by 70%, while in alcoholic rats - only by 6%!

With the introduction of alcohol into the stomach, a third of the fetuses are dead, and the survivors are much smaller in weight than in the control group. Similar processes can occur in the human body.

The most common reason for drinking alcohol among schoolchildren is: shyness towards the opposite sex, the desire to seem like an adult, to be like everyone else.

Coffee is obtained from the beans of the coffee tree. The active ingredient is caffeine. The lethal dose of pure caffeine is 10-20 grams orally. The toxic effect is associated with a sharp excitation of the central nervous system. When drinking strong coffee, a person's heart rate increases, pupils dilate, blood pressure rises, and a feeling of cheerfulness appears. There is an addiction to coffee consumption. caffeine is a drug. Therefore, people who have not received their daily norm of cups of coffee are irritated, they are haunted by weakness, headache, muscle pain.

From the review of the literature it follows that all the selected substances are very toxic to the body, as they contain a lot of poisonous, toxic substances. They have a stronger effect on a young, growing organism and are very dangerous during the prenatal development of humans and animals.

The impact of alcohol-containing substances on the cardiovascular and respiratory systems of amphibians

Substance
Substance	Primary	Primary

Substance
Substance	initial	initial
Beer + Balkan Star
Beer + "Alliance"
Beer + Bond

Average data on the impact of alcohol-containing substances on the body of an amphibian.

Substance
Substance	initial	Average	initial	Average

The result of the impact of alcohol and nicotine-containing substances on the body of an amphibian.

Substance
Substance	initial	initial
Beer + Balkan Star
Beer + "Alliance"
Beer + Bond

Alcohol poisoning in Russia is the most common among other poisonings. It accounts for about 60% of deaths. An even greater proportion of deaths occur before medical care is provided in 95% - 98% of cases.

Most alcoholic beverages contain ethanol (ethyl alcohol). This is a chemical substance, it is colorless, volatile, highly flammable, quickly spreads throughout the body and is absorbed into the blood, penetrating through the membranes.

Symptoms of alcohol poisoning

Alcohol poisoning is divided into 3 types according to the state:

Alcohol intoxication (mild, moderate, severe, coma)

A slight disturbance of consciousness, elated mood, arousal initially manifests itself, then a slowdown in activity and arousal begins, a depressed state comes in turn, the person’s consciousness slows down, becomes sleepy and slow.

alcohol poisoning
The state is lethargic, inhibited, drowsy, coma development.
Alcohol intoxication
The toxic effect of ethanol decay products on the human body.

Organ lesions and their symptoms:

Gastrointestinal tract - lesions of the mucous membrane of the stomach and small intestine, diarrhea occurs due to malabsorption of water and minerals, as well as fats, with a decrease in the number of enzymes that are responsible for the absorption of lactose. There are symptoms of intoxication in the form of nausea and vomiting with a toxic effect on the nervous system. With the defeat of the nervous system, there is a bret, hallucinations, mental agitation, impaired coordination, attention, memory, speech, violation of thermoregulation. Pupils dilate.

The action of ethanol occurs on the nervous system, while the metabolism of nerve cells is disturbed with the occurrence of oxygen starvation. Intoxication of ethanol decomposition products affects ketone bodies, acetate, acetaldehyde.

When ethanol affects the cardiovascular system, the heart rate increases, blood pressure drops, dizziness, loss of strength occur, while the skin turns pale and the face turns red.

The respiratory system is affected causing metabolic disorders with the development of cerebral edema. Acute respiratory failure appears, the tongue sinks with a reflex spasm of the larynx. Breathing becomes rapid.

Damage to the kidneys by ethanol and a violation of the water-salt balance, while the symptoms of alcohol poisoning are manifested in the form of frequent urination or infrequent urination, to the point of its absence. This happens due to a decrease in the secretion of hormones of the hypothalamus, which retains water. Ethanol is able to remove from the body all the mineral substances necessary for a person (potassium, calcium, magnesium, etc.), absorption into the intestines is disturbed and a deficiency of vitamins and minerals occurs. In some cases, ethanol damages the structure of the kidneys.

Damage to the liver and its cells leads to a violation of intracellular metabolism, pain appears in the right hypochondrium, sometimes yellowness of the skin appears.

Severe alcohol poisoning

In severe cases, with alcohol poisoning, a person falls into a coma. Who is able to cause ethanol if its concentration in the blood reaches 3 g per liter of blood.

Who is divided into 2 phases:

Deep coma - loss of consciousness, complete absence of external stimuli, loss of reflexes, pain, decrease in body temperature. Pale to bluish skin, low blood pressure, rapid heart rate, deep breathing.

superficial coma- loss of consciousness, decreased sensitivity, floating movement of the eyeballs, with one pupil larger than the other. There is a reaction to external stimuli with facial expressions, the eyes are often reddish. Breathing and palpitations are speeded up, profuse salivation is also noticed.

The effect of alcohol on the body

The severity of alcohol poisoning can depend on various factors.

1 Amount of alcohol consumed:

If a person drinks a large amount of alcohol at a time, his liver does not have time to process alcohol. And ethanol accumulates in the blood, while destroying important organs for life, such as the brain, kidneys, liver, stomach, heart, etc.

A healthy human liver, whose weight is approximately 75-85 kg, can process only 8 grams of pure alcohol in one hour (100 ml of vodka contains 31 grams of pure alcohol.) Therefore, even 100 grams per hour is already a huge amount for organs our system.

With all this, alcohol will have the worst effect on children and the elderly, since in children it is not yet fully formed, and in the elderly the mechanisms do not perform their work so well.

2 Much depends on the genetic predisposition, some alcohol is absorbed quickly, others slowly, some have low activity of the enzyme that is responsible for the processing of ethanol, others vice versa. Intoxication occurs if the breakdown product of ethanol, acetaldehyde, accumulates in the blood. In addition, a person's health factors will affect, for example, if he already has an unhealthy liver, kidneys, diabetes mellitus or other diseases. No less important is lifestyle, such as pregnancy, malnutrition, overwork, which can also affect the absorption of alcohol.

3 Everyone knows that alcoholic beverages should not be mixed with drugs, since the effect of alcohol is only aggravated, especially for antipsychotics, trunks, antidepressants and other neuropsychiatric drugs. While taking conventional drugs, ethanol will only drown out their actions and there will be no sense from them.

This also includes the intake of various additives, in which the toxic effects of alcohol are enhanced. Additives include (methyl alcohol, aldehydes, furfural, ethylene glycol, etc.).

4 In a fairly short time, half of the accepted dose of alcohol is already absorbed into the blood (about 15-20 minutes), so drinking it on an empty stomach only exacerbates the effect, however, when taking alcohol and carbohydrate food at the same time, it significantly reduces the rate of absorption of ethanol into the blood.

In general, with a large and frequent use of alcohol, the heart may not be able to withstand and the person will simply die, such cases occur every year. Especially cases after taking alcohol in the form of cologne, lotion, troy, hawthorn and similar substances. Methyl alcohol, which is contained in these liquids, is oxidized in the body to formaldehyde and formic acid, which cause severe intoxication on the body. After that, a headache, nausea, abdominal pain, double vision, flies, fog, in the flesh to blindness begin. It especially affects the optic nerve and the retina of the eye. If the pupil is dilated for a long time during poisoning, then this is a symptom of unfavorable consequences. Death occurs when there is a violation of breathing, heart or brain paralysis.

First aid for alcohol poisoning

Correctly lay the patient on his side Ensure the patency of the airways, if the tongue is sunk, straighten it, or press the tongue with your fingers, a spoon, do everything so that it does not sunk. Using a rubber pear, remove the contents of the oral cavity, this is mucus, salivation, the remnants of vomiting. With abundant salivation, intravenously deliver atropine 1.0-0.1% This is the most common cause of death if the tongue or other contents interfere with full breathing.

If breathing stops, you need to perform a heart massage - 2 breaths and 30 chest compressions (is a cycle of resuscitation) Repeat until breathing appears. Pressing must be effective. This method is able to re-engage the cardiac and respiratory systems.

The classic way to bring the patient to consciousness is to bring a cotton swab with ammonia at a distance of 1 cm. It stimulates the respiratory organs, awakening them.

If the patient is conscious, give him the opportunity to clear the stomach, for this you need to drink a saline solution (200 ml 1 teaspoon of salt). It is effective in the first hours. Next, take ipecac root (200 ml per 2 teaspoons), it can cause vomiting, this is necessary to cleanse the stomach. If possible, perform gastric lavage through an umbrella (water can be salted for 1 liter of water 1 teaspoon)

Since alcohol causes peripheral vasodilation, the body loses heat. Therefore, try to warm the patient.

Medicines for poisoning

White charcoal: 3-4 tablets, up to 3-4 times a day

Enterosgel: 6 tablespoons, once

Polysorb: Adults 2-3 tablespoons, place in ¼-½ cup of water.

Activated charcoal: 1 gram per 10 kg of patient weight, 1 tab. \u003d 0.25 gr. The average daily dose is 20-30 gr., 80-120 tab.

Metadoxil: dose 300-600 mg (5-10 ml), intramuscularly; Or add 300-900 mg of metadoxil to 500 ml of saline or 5% glucose solution, inject intravenously over 90 minutes.

Catad_tema Alcohol addiction - articles

The toxic effect of alcohol

ICD 10: T51

Year of approval (revision frequency): 2016 (review every 3 years)

ID: KR499

Professional associations:

Association of Clinical Toxicologists

Approved

Interregional charitable public organization "Association of Clinical Toxicologists"

Agreed

Scientific Council of the Ministry of Health of the Russian Federation __ __________ 201_

alcohol

ethanol

propyl alcohol

isopropyl alcohol

amyl alcohol

butyl alcohol

alcohol, unspecified

chemical-toxicological diagnostics

pathological syndromes

accelerated detoxification

List of abbreviations

BP - blood pressure

ADH - alcohol dehydrogenase

ALAT - alanine transferase

ASAT - aspartate transferase

GGTP - gamma-glutamyl transpeptidase

GGTP - gamma-glutamyl transferase

HD - hemodialysis

HDF - hemodiafiltration

GLC - gas liquid chromatography

GIT - gastrointestinal tract

IVL - artificial lung ventilation

KOS - acid-base state

CT - computed tomography

CPK - creatine phosphokinase

LDH - lactate dehydrogenase

ICD10 - International Statistical Classification Classification of Diseases and Related Health Problems, Tenth Revision

MRI - magnetic resonance imaging

ARDS - acute respiratory distress syndrome

ICU - intensive care unit

PZh - gastric lavage

Ultrasound - ultrasonography

FBS - fibrobronchoscopy

FD - forced diuresis

CVP - central venous pressure

AP - alkaline phosphatase

EC - ethyl alcohol

EGDS - esophagogastroduodenoscopy

ECG - electrocardiography (cardiogram)

EEG - electroencephalography

EAPCCT – European Association of Poison Centers and Clinical Toxicologists

LD - lethal (lethal) dose

Rg - radiograph

Terms and Definitions

Alcohol- Chemically, alcohols include any monohydric alcohol in the series - methyl, ethyl, propyl, butyl, etc. In ICD 10, in the broad sense of the word, under the term "alcohol", appearing in the heading T.51 "Toxic effect of alcohol", various monohydric alcohols are meant - ethyl (ethanol), methyl (methanol), propyl (propanol), etc. In everyday life in Russia, official, special scientific literature, the media, the concept and, accordingly, the name "alcohol" is associated with ethyl alcohol (ES), which has a code in ICD 10 - T51.0 Thus, the term alcohol is essentially used as a synonym for alcoholic beverages.

Alcohol intoxication- a phrase that characterizes a health disorder caused by excessive consumption of alcoholic beverages. Historically, the term "alcohol intoxication" is used by medical specialists of various profiles, including toxicologists, psychiatrists-narcologists (mainly), forensic doctors. Currently, the concept of "alcohol intoxication" is present in the ICD10 under the code F10 - Mental and behavioral disorders caused by alcohol, including: F.10.0 "Acute intoxication" - as acute intoxication with alcoholism and alcohol intoxication. At the same time, it is customary to distinguish the following clinical forms: acute alcohol intoxication: simple alcohol intoxication; altered forms of alcohol intoxication; pathological intoxication; chronic alcoholism 1, 2, 3 stages; alcoholic psychoses (alcoholic delirium, acute alcoholic hallucinosis, acute alcoholic paranoid, etc.). "Chronic alcohol intoxication" characterizes a disease that has developed as a result of prolonged abuse of ES and is not accompanied by coma (with the exception of the terminal stage of multiple organ failure). For this disease, various behavioral and mental disorders are more characteristic. The substitution of the concepts of "alcohol intoxication", "acute alcohol intoxication" and "alcohol poisoning" often leads to incorrect diagnosis, hospitalization and therapy of the victim.

Alcoholic coma– a coma that has developed as a result of the use of ES mainly in the form of alcoholic beverages in a toxic / lethal dose with the appearance of a toxic / lethal concentration of ethanol in the blood.

Detoxification- the process of neutralization and removal of a toxic substance from the body that has come from outside. Detoxification, as a natural process of protecting the body from a toxicant, includes various mechanisms aimed at converting the poison into non-toxic compounds (metabolites), carried out mainly in the liver, removing the poison or its metabolites in various ways - through the kidneys, intestines, liver, lungs, skin. In the process of natural detoxification, metabolites can be formed that are more toxic than the toxicant that has entered the body (lethal synthesis), in addition, going through the process of metabolism in the liver, excreted through the kidneys, the toxicant and its toxic metabolites can lead to damage to these organs and the development of acute renal or liver failure.

Detox accelerated In order to more intensively remove the toxicant from the body, various methods of accelerated detoxification are used, such as forced diuresis (medicated increase in urination), cleansing of the gastrointestinal tract (gastric lavage, administration of laxatives, enterosorbents, intestinal lavage), extracorporeal methods of extrarenal cleansing of the body (hemodialysis and its modifications, hemosorption, peritoneal dialysis, plasmapheresis, etc.).

Disease- arising in connection with the influence of pathogenic factors, a violation of the body's activity, working capacity, ability to adapt to changing conditions of the external and internal environment with a simultaneous change in protective-compensatory and protective-adaptive reactions and mechanisms of the body.

Instrumental diagnostics- diagnostics using various devices, devices and tools for examining the patient.

Intoxication- Violation of vital activity caused by toxic substances penetrating the body from the outside or formed in it in violation of various biochemical processes and functions of the excretory organs and leading to the development of endotoxicosis Small Medical Encyclopedia. Intoxication is a broader pathological process, including not only and not so much exogenous, but perhaps more endogenous toxicosis.

Laboratory diagnostics- a set of methods aimed at analyzing the material under study using various specialized equipment.

Poisoning- a disease that develops as a result of external (exogenous) effects on the human or animal body of chemical compounds in quantities that cause violations of physiological functions and endanger life

Alcohol poisoning(or ethanol) - a coma, acutely developed as a result of the use of a toxic dose of ES. A state that is not accompanied by loss of consciousness after the use of ES is regarded as alcohol intoxication, which does not require emergency medical care, since a person comes out of the state of intoxication on his own.

Syndrome- a set of symptoms with common etiology and pathogenesis.

Somatogenic stage of poisoning- the period of the course of an acute chemical disease, which begins after the removal from the body or destruction of a toxic substance in the form of a trace lesion of the structure and functions of various organs and systems of the body, manifested, as a rule, by various somatic, neuropsychiatric complications, such as pneumonia, acute renal, liver failure, toxic polyneuropathy, anemia, psychoorganic syndrome, etc. At this stage of poisoning, specific (antidotal) therapy is not required, and detoxification can only be directed to the treatment of endotoxicosis.

State- changes in the body that occur due to the impact of pathogenic and (or) physiological factors and require medical care;

Alcohol surrogates- substitutes for alcoholic beverages used for the purpose of intoxication, which are substances from the group of monohydric, polyhydric alcohols, organic solvents, which have a narcotic effect on the central nervous system, similar to the effect of ethanol, but, as a rule, have a higher toxicity. They are used in everyday life and production for technical purposes and are not intended for ingestion. ICD10 does not contain the subheading "toxic effect of alcohol surrogates".

Toxigenic stage of poisoning- the period of the course of an acute chemical disease, starting from the moment a toxic substance enters the body in a concentration capable of causing a specific effect and continuing until the moment it is removed. It is characterized by the specificity of clinical manifestations, reflecting the chemical and toxicological properties of a toxic substance, its effects on target organs. The severity of this period of the disease is directly dependent on the dose of the poison taken, its concentration in the blood. The main therapeutic task in this period is to reduce its duration as early as possible by using various methods of accelerated detoxification, antidote, symptomatic therapy.

1. Brief information

1.1 Definition

Alcohols are an extensive and very diverse class of organic compounds: they are widely distributed in nature, are of great industrial importance and have exceptional chemical properties.

Aliphatic saturated alcohols with a long chain of up to 5 carbon atoms (methyl, ethyl, propyl, butyl and amyl) have the greatest toxicological significance.

The toxic effect of alcohol(according to the ICD10 wording) implies a health disorder caused by the ingestion of one or more representatives of this group and is interpreted as acute poisoning. At the same time, from the standpoint of clinical characteristics, the leading value, both in terms of the frequency of occurrence of this pathology and medical consequences, is poisoning with ES (ethanol) or a commonly used concept - alcohol poisoning, which, from the standpoint of toxicologists, is a disorder of consciousness (coma) caused by excessive simultaneous intake of ethanol. Poisoning with other alcohols of this group can manifest itself with various symptoms with preserved consciousness.

Given the higher toxicity and the specificity of clinical manifestations and complications, these recommendations do not consider the toxic effect (poisoning) of methanol (methyl alcohol), which is separated into separate clinical recommendations.

1.2 Etiology and pathogenesis

Alcohols included in the T51 group are characterized by limited volatility and, with relatively low toxicity, acute inhalation alcohol poisoning in clinical practice practically does not occur, with the exception of cases of inhalation use of some alcohols (isopropyl) and some technical formulations containing alcohols for the purpose of drug intoxication. The most common in clinical practice are acute oral poisoning with alcohols used for the purpose of intoxication.

Acute alcohol poisoning usually occurs when taking ethyl alcohol or various alcoholic beverages with an ethyl alcohol content of more than 12%. The lethal dose of 96% ethanol ranges from 4 to 12 g per 1 kg of body weight (approximately 700-1000 ml of vodka in the absence of tolerance). Alcoholic coma occurs when the concentration of ethanol in the blood is 3 g / l and above, death - at a concentration of 5-6 g / l and above. Poisoning, as a rule, is of the nature of household - accidental, with the aim of intoxication.

Poisoning with pure higher alcohols - propyl, butyl, amyl alcohols are much less common in toxicological practice than with ethyl alcohol, poisoning with their mixture with ethyl alcohol is more common. Lethal doses and concentrations: cases of fatal poisoning by ingestion are described - 0.1-0.4 liters of propyl alcohol or more. Death occurred in the period from 4-6 hours to 15 days, coma - when the content of propanol in the blood was about 150 mg%. However, fatal poisoning is also described when 40 ml of alcohol is ingested. The lethal dose (LD100) of isopropyl alcohol by mouth for adults is considered to be 240 ml, lethal concentration levels vary from 0.04 mg/l in children and 4.4 mg/l in adults. Routes of entry into the body - inhalation, oral, percutaneous, however, in clinical practice, poisoning as a result of oral intake of these alcohols predominates.

Fusel oil is a mixture of higher (C3 - C10) monohydric aliphatic alcohols, ethers and other compounds. Higher alcohols with up to 10 carbon atoms are soluble in water. From a toxicological point of view, the oral route is important. Despite the fact that fusel oils are present in a number of alcoholic legal drinks, individual representatives of monohydric alcohols, as independent chemicals, have the main clinical and toxicological significance.

Butyl alcohols (C4H9OH) - colorless liquids with a characteristic alcohol odor are used as solvents in the perfumery and pharmaceutical industries, in the production of synthetic rubber, for the manufacture of brake fluid BSK (containing up to 50% butanol), etc.

Amyl alcohols (С5Н11ОН) exist in the form of 8 isomers of amyl alcohol (primary, secondary, tertiary amyl and isoamyl alcohols, diethyl carbinol, sec-butyl carbinol, etc.), which are obtained during oil refining. The main practical value is normal amyl alcohol, the main component of fusel oil - an oily product of alcoholic fermentation. Butyl, amyl alcohols can cause damage by inhalation, skin contact, however, they pose the greatest danger when ingested when used for the purpose of intoxication, or mistakenly in "pure form" or as part of solvents or other technical fluids.

The generality of the physicochemical properties of alcohols ultimately determines the similarity of the toxicokinetics of these compounds. All representatives of this group, entering inside, are quickly absorbed into the blood from the stomach and upper sections of the small intestine, and are fairly evenly distributed in the body. The exception is alcohols containing 6 or more carbon atoms, which can accumulate in adipose tissue due to high lipophilicity.

ES is quickly absorbed into the blood from the gastrointestinal tract (up to 80% in the small intestine) and is fairly evenly distributed in organs and tissues, while two distinct phases are distinguished in the toxicokinetics of ethanol: resorption (absorption) and elimination (excretion).

In the resorption phase, the rate of saturation of organs and tissues with ethanol is much faster than its biotransformation and excretion, as a result of which an increase in its concentration in the blood is observed. After oral administration, the maximum concentration of ethanol in the blood is reached after 1-2 hours.

The elimination phase occurs after the absorption of more than 90% of alcohol. To determine the above phases of the distribution of ethanol, the ratio of the levels of its concentration in urine and blood is calculated. In the resorption phase, this is the average ratio<1, а в фазе элиминации - всегда >1.

Phase determination is of great diagnostic and forensic importance.

About 90% of ES is oxidized by the liver with the participation of the enzyme alcohol dehydrogenase to CO2 and H2O, the remaining 10% is excreted unchanged through the lungs and kidneys within 7–12 hours. The rate of ethanol metabolism in the human body is on average 90–120 mg/kg of body weight per hour, but this figure can vary significantly depending on individual characteristics.

Organs with intensive blood supply (brain, liver, kidneys) are saturated with ethanol for several minutes with the establishment of a dynamic balance of the level of ethanol in the blood and tissues. Food masses in the stomach slow down the absorption of alcohol, and when taken on an empty stomach or with repeated doses, as well as in people with stomach diseases, the resorption rate is higher.

The excretion of alcohol from the body is carried out unchanged with urine and exhaled air, and in the urine it is determined much longer than in the blood. The excretion of ethanol does not depend on the pH value, while its acidic metabolites are better excreted by urine, which has an alkaline reaction.

The biotransformation of ethanol is carried out mainly in the liver with the formation of products that are excreted mainly by the kidneys.

Ethanol has a psychotropic effect due to narcotic effects on the central nervous system (CNS). In severe poisoning, a weakening of the excitation processes occurs, which is due to a change in the metabolism of the brain cell, a violation of the function of mediator systems, and a decrease in oxygen utilization. The severity of the narcotic effect of ethanol depends on its concentration in the blood, including the rate of its increase in the blood in the resorption phase, in which the narcotic effect of ethanol is higher than in the elimination phase at the same concentrations in the blood; the degree of development of the patient's tolerance to alcohol.

The leading place in the pathogenesis of acute alcohol poisoning, along with cerebral disorders, is occupied by respiratory disorders of various origins. The hypoxia formed as a result of these processes exacerbates cerebral disorders and homeostasis disorders (acid-base state, water-electrolyte balance, interstitial metabolism, etc.). This is facilitated by hypoglycemia, which often develops in chronic alcoholics against the background of acute alcohol intoxication.

At the heart of hemodynamic disorders in acute alcohol poisoning is a violation of vascular tone, relative, less often absolute hypovolemia, impaired microcirculation as a result of acidosis, hypercoagulation and hypothermia.

In addition, it is possible to develop a nonspecific cardiotoxic effect most often against the background of a previous pathology of the cardiovascular system (alcoholic cardiomyopathy, etc.)

In the somatogenic stage of poisoning, the main place is occupied by residual cerebral disorders, damage to internal organs, primarily the liver, kidneys, myocardium and pancreas, as well as infectious complications (mainly pneumonia), which leads to disruption of all vital functions. Cardiac arrhythmias are possible, including fatal ones, associated with developed alcoholic cardiomyopathy against the background of chronic alcohol intoxication.

Higher alcohols cause intoxication similar to alcohol. They are oxidized in the body with the participation of alcohol dehydrogenase, microsomal ethanol-oxidizing system and aldehyde dehydrogenase to the corresponding aldehydes and acids.

The acute toxicity of higher alcohols is 1.5 - 3 times higher than the toxicity of ethanol. In accordance with this, higher alcohols and fusel oils are classified as moderately toxic compounds.

Isopropyl (propyl) alcohol can enter the body orally, inhalation and precutaneous. The metabolite of isopropyl alcohol is acetone, which slowly oxidizes to CO2 and H2O. In total, 30-50% of the dose is metabolized. 82% of isopropyl alcohol is absorbed from the gastrointestinal tract in the first 20 minutes and almost ends after 2 hours.

In adults, the elimination half-life of isopropanol and its metabolite acetone is 2.9–16.2 hours (with an average time of 7 hours) and 7.6–26.2 hours, respectively. Due to the good solubility in fats, propyl alcohols can linger in the body for quite a long time. The release of isopropyl alcohol and acetone with exhaled air begins 15 minutes after ingestion of alcohol. Excretion of isopropyl alcohol and acetone also occurs in the urine; the release of acetone, depending on the dose of isopropyl alcohol, can continue for a number of days.

Butyl alcohol can enter the body by inhalation and oral route.

During inhalation of 1-butanol, about 55% is absorbed, but it is rapidly excreted: 1 hour after the inhalation is stopped, it is absent in the exhaled air. Upon entering the stomach, butyl alcohols are rapidly absorbed: after 2-3 hours they disappear from the blood (tert-butyl alcohol was also detected after 24 hours). The maximum accumulation is in the liver and blood. Oxidation to butanol, butanoic and acetic acids occurs.

About 83% of 2-butanol is excreted in exhaled air, 4-5% in urine and less than 1% in feces.

Vapors are irritating to the mucous membranes of the upper respiratory tract and eyes. When exposed to the skin, dermatitis and eczema can occur the sooner, the higher the content of unsaturated compounds in butyl alcohol (butyl alcohol and crotonaldehyde, etc.) formed during its industrial production. Butyl alcohol causes a narcotic effect; in this case, the central nervous system is affected, especially the subcortical formations of the brain.

The lethal dose of butyl alcohol when taken orally - according to various sources, from 30 to 200-250 ml. Smaller doses can cause severe poisoning with intracranial hemorrhages and visual disturbances (changes in the fundus, narrowing of the visual fields, atrophy of the optic nerve and blindness).

Amyl alcohol after oral administration, it circulates in the blood for several hours (various isomers - from 4 to 50 hours); its decomposition products are aldehydes and ketones; Excretion from the body occurs through the lungs and in the urine.

By the nature of the action on the body, amyl alcohols are drugs with a strong local irritant effect. First of all, the nervous system is affected and paralysis of the vital centers of the brain stem occurs.

Alcohol poisoning caused by moonshine or other surrogates with a high content of monohydric aliphatic alcohols is characterized by rapid development, longer duration, deeper impairment of consciousness, epileptiform CNS disorders and severe post-toxication syndrome. Frequent use of such surrogates contributes to the rapid development of the psycho-organic syndrome.

1.3 Epidemiology

Acute ES poisoning is one of the leading causes of emergency hospitalization for poisoning. According to the reports of the toxicological centers of Russia (Form No. 64), patients with this pathology accounted for 37.4%, 42.9%, 36.9%, 30.7%. of all hospitalized in these units in 2008 - 2011, respectively. In 2015, this figure averaged 32.7%. In federal districts, the proportion of patients hospitalized with ethanol poisoning in 2015 ranged from 7.1% in the Northwestern Federal District to 69% in the Urals and Siberian Federal Districts. The average hospital mortality rate for ethanol poisoning was 3.0% in 2005-2012, and 4.7% in 2015. Mortality due to ethanol poisoning in relation to other causes of deaths due to poisoning in the Russian Federation is the leading factor for the same period, ranging from 55.8% in 2005 to 42.1% in 2012, 2015 - 43, 7%, other alcohols - 3.3% - 4.0%.

1.4 Coding according to ICD10

Toxic effect of alcohol (T51):

T51.0 - Toxic effect of ethanol (ethyl alcohol);

T51.2 - Toxic effect of 2-propanol (propyl alcohol);

T51.3 - Toxic effect of fusel oils (alcohol: amyl; butyl; propyl;

T51.8 - Toxic effect of other alcohols;

T51.9 - Toxic effect of alcohol, unspecified;

1.5 Classification

Classification of coma due to the toxic effect (acute poisoning) of ethanol, which is subdivided by depth, respectively

coma superficial uncomplicated,

coma superficial complicated,

deep coma uncomplicated

coma deep complicated.

Toxic effect of alcohols:

2-propanol (propyl alcohol),

fusel oils (alcohol: amyl;

butyl; propyl

classified according to severity:

mild - not accompanied by loss of consciousness,

moderate severity - with a disorder of consciousness according to the type of stupor condition, toxic encephalopathy, but without complications,

severe - characterized by complete loss of consciousness (coma), which may be accompanied by various complications.

2. Diagnostics

2.1 Complaints and medical history

With ethanol poisoning, there are practically no complaints, since the patient is unconscious. In case of poisoning with higher alcohols with preserved consciousness, complaints are characteristic of exposure to narcotic and irritating substances: weakness, dizziness, headache, pain in the epigastric region, nausea, vomiting. In case of poisoning with butanol, amyl alcohols, there may be complaints of diarrhea.

The anamnesis should be aimed at clarifying the following data: type of toxic substance (vodka, wine, beer, technical alcohol, solvent - its name, trade mark, etc.), dose, time of taking the toxicant.

In addition, it is advisable to find out some data from the anamnesis of life: previous diseases, injuries, bad habits.

Most often, an anamnesis can be collected only after the patient’s consciousness is restored, since ethanol (alcohol) poisoning is a coma, and the victims are usually delivered by ambulance teams from public places, the streets on the call of random passers-by, however, even in this case, the person who came into consciousness, the patient is far from always able to remember and report the necessary anamnestic information.

2.2 Physical examination

In case of poisoning with ethanol, higher alcohols, it is recommended to evaluate the following:

The appearance of the skin - there is no specific color, in case of respiratory failure, shock, cyanosis of the lips, face, acrocyanosis, cold snap is noted, with a deep coma there may be moisture. It is necessary to identify the presence / absence of a rash, local changes, the so-called. “Decubitus ulcers” due to positional injury due to pressure from one’s own body weight, the so-called positional pressure on certain areas of soft tissues, leading to the appearance of areas of skin hyperemia, which are often regarded as bruises, hematomas, burns, phlebitis, allergic edema, etc. and are usually detected in the early stages (1-3 days).

Assess the psychoneurological status: state of consciousness (clear, lethargy, stupor, coma, psychomotor agitation, hallucinations). In the presence of coma - assess its depth, the presence or absence of reflexes, the width of the pupils, their reaction to light, the presence (absence) of anisocoria, the state of muscle tone. When detecting anisocoria, pathological reflexes, pay attention to their constancy (“pupil play”), since with a superficial alcoholic coma, anisocoria and pathological reflexes can appear and quickly disappear.

Assess the state of breathing: adequacy, frequency, depth, uniformity of participation in the act of breathing of all parts of the chest, auscultatory picture.

Examine visible mucous membranes - some higher alcohols are irritating and can cause a burning sensation, pain when swallowing.

Pay attention to the presence / absence of injuries, especially in the face, head, abdomen, lower back.

Pay attention to the presence / absence from the exhaled air of a smell characteristic of ES, higher alcohols, but it is not an absolute fact confirming ES poisoning, since the state of alcoholic intoxication can accompany various somatic, infectious diseases, injuries.

2.3 Laboratory diagnostics

2.3.1 Chemical-toxicological laboratory diagnostics

The basis is chemical-toxicological laboratory diagnostics. Of the modern express methods for the qualitative and quantitative determination of ethanol, gas-liquid chromatography (GLC) with the use of a flame ionization detector or a thermal conductivity detector has an indisputable advantage, providing high accuracy (sensitivity 0.005 g/l of ethanol) and specificity of the study and allowing along with the main study to identify in biological fluids, a number of substances characterized by a narcotic effect (aliphatic alcohols (C1-C5), ketones, industrial chlorine and organofluorine derivatives, aliphatic and aromatic hydrocarbons, glycols and esters). It is not recommended to use for the purpose of diagnosis the determination of the presence and level of ES in the blood using the analysis of exhaled air (alcometer), since this method does not allow determining the presence of other alcohols, is inferior in accuracy to GLC, and also does not allow obtaining the required amount of exhaled air (maximum complete active expiration) in a patient in a coma).

Persuasiveness level - D(level of evidence - 4)

The determination of ethyl alcohol in blood and urine is recommended to be carried out 2 times with an interval of 1 hour in order to confirm the result of the first study and determine the phase of poisoning by the ratio of ethanol concentration in these biological media (resorption or elimination).

Persuasiveness level - D(level of evidence - 4)

Comments:The average concentration of alcohol in the blood upon admission of patients in a coma is 3.0-5.5 g / l, in children the toxic effect of alcohol without the onset of coma is observed at an ethanol concentration in the blood of 0.9-1.9 g / l, coma develops at an ethanol level of 1.6 g/l. However, there is no complete correlation between the depth of coma and the concentration of ethanol in the blood, although there is a tendency to deepen the coma as the amount of alcohol in the blood increases. Moreover, the same concentrations are sometimes found in persons in a state of alcoholic intoxication and alcoholic coma. Therefore, a single indicator of the concentration of ethanol in the blood cannot serve as a criterion for the severity of alcohol poisoning. In this regard, it is necessary to determine the ratio of alcohol concentrations in biological media after a second study, which, in addition to clinical, this ratio also has forensic medical significance.

The GLC method is provided with domestic analytical equipment available in our country and is not dangerous for the patient.

For patients in a superficial coma, a single determination of the presence and level of ethanol is recommended.

Persuasiveness level - D(level of evidence - 4)

Patients in a deep coma with an initially high level of ethanol in the blood are recommended to be re-examined (after detoxification), especially in the case of insufficiently fast positive clinical dynamics of recovery of consciousness.

Persuasiveness level - D(level of evidence - 4)

With a deep coma, a repeated 2 or 3-fold study (qualitative and quantitative) is recommended, depending on the clinical situation. Given that the metabolite of isopropanol is acetone, the detection of the latter in an amount exceeding the allowable level of metabolic acetone (for example, in diabetes mellitus) can be regarded as an indirect confirmation of the use of isopropanol.

Persuasiveness level - D(level of evidence - 4)

Comments: Blood sampling rules . Blood in the amount of 15 ml is taken by gravity into the syringe, placed in 2 bottles of 10 and 5 ml, containing 3-5 drops of heparin solution for every 10 ml of blood, and tightly closed with lids or in the same volumes using vacuum tubes. Urine in an amount of at least 5 ml is also taken into the vial and tightly closed with a stopper.

Important: when taking blood for ethanol, other alcohols and volatile compounds, the skin at the insertion site of the blood sampling needle must not be treated with ethyl alcohol, because. this will lead to false results.

Additional chemical-toxicological diagnostics is recommended for suspected combination of poisoning with alcohol and psychoactive substances (drugs, psychotropic drugs), other alcohols, chlorinated and aromatic hydrocarbons. Research methods will depend on the toxicant being determined.

Persuasiveness level - D(level of evidence - 4)

2.3.2 Clinical and biochemical laboratory diagnostics

It is strongly recommended that all patients perform a general (clinical) blood test, urine, biochemical blood test (determination of total bilirubin, direct bilirubin, total protein, glucose, urea, creatinine). The frequency of these studies will depend on the severity of the poisoning and the length of the patient's stay in the hospital.

Persuasiveness level - D(level of evidence - 4)

For the differential diagnosis of poisoning with alcohol and other toxicants that cause impaired consciousness, it is recommended to determine the level of glucose in the blood, the determination of CBS, in order to assess the state of homeostasis and indirectly detect methanol and ethylene glycol poisoning, which are characterized by the development of decompensated metabolic acidosis.

Persuasiveness level - D(level of evidence - 4)

With the development of hepatopathy, liver failure, the determination of aldolase, alkaline phosphatase, GGTP, GGTP, prothrombin time, coagulogram, bilirubin fraction, protein fractions is recommended.

Persuasiveness level - D(level of evidence - 4)

2.4 Instrumental diagnostics

Instrumental diagnostics has no specifics and is carried out for the purpose of differential diagnosis and monitoring of the patient's condition.

electrocardiography (ECG) - the probability of the presence of cardiomyopathy, chronic cardiac pathology (especially since the history of the life of such patients upon admission to the hospital is practically unknown),

chest radiography,

x-ray of the skull in two projections - for patients brought from the street, public places, in the presence of traces of injuries.

esophagogastroduodenoscopy (EGDS) - higher alcohols have a local irritating effect on the mucous membrane of the digestive tract (up to 2 times).

Persuasiveness level - D(level of evidence - 4)

Additional instrumental diagnostic methods are recommended to be performed once in order to identify trauma, comorbidity or possible complications (ultrasound examination (ultrasound) (ECHO-scopy) of the brain, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, ultrasound of the abdominal organs, kidneys, pancreas, fibrobronchoscopy FBS.

Persuasiveness level - D(level of evidence - 4)

2.5 Differential diagnosis

At the stage of primary health care, it is recommended to exclude the disease or condition that caused the coma on the background of alcohol intoxication, in particular:

traumatic brain injury, acute cerebrovascular accident;

hypoglycemic coma;

infectious disease (meningitis, encephalitis, etc.)

hepatic and uremic coma, coma with endocrinological diseases, severe encephalopathy with water-electrolyte and metabolic disorders.

Persuasiveness level - D(level of evidence - 4)

In the hospital, upon admission of the patient, it is also recommended to exclude the diseases or conditions listed above, and in the absence of positive dynamics after 2.0-4.0 hours after the start of infusion therapy, a more in-depth study is recommended, including chemical-toxicological, in order to exclude the presence of a combined intake of any - or psychotropic drugs or other somatic or infectious disease.

Persuasiveness level - D(level of evidence - 4)

3. Treatment

At the stage of primary health care, it is recommended to normalize impaired breathing and restore or maintain adequate hemodynamics (see 3.1 "Treatment of hemodynamic disorders".

Persuasiveness level - D(level of evidence - 4)

in cases of aspiration-obstructive respiratory disorders, it is recommended to perform an oral toilet; to reduce hypersalivation and bronchorrhea, atropine ** (1-2 ml of a 0.1% solution) is injected subcutaneously;
with a superficial coma - aspiration of the contents of the upper respiratory tract is carried out using an air duct;
with a deep coma - tracheal intubation is performed.
in case of respiratory failure of the central type, it is necessary to carry out artificial ventilation of the lungs after preliminary intubation of the trachea.
with a mixed form of disorders, aspiration-obstructive respiratory disorders are first eliminated, and then artificial lung ventilation is connected.
inhalation of oxygen is shown.
to resolve atelectasis - a sanitation FBS.

Persuasiveness level - D(level of evidence - 4)

3.1 Treatment of hemodynamic disorders

In severe hemodynamic disorders, anti-shock therapy is recommended: intravenous plasma-substituting solutions, saline solutions and glucose solutions.

Persuasiveness level - D(level of evidence - 4)

After relief of respiratory failure and associated hypoxia, the use of succinic acid preparations (solution of meglumine sodium succinate ** - 1.5% - 400.0) and cardiovascular agents in therapeutic doses (cordiamin, caffeine) is recommended.

Persuasiveness level - D(level of evidence - 4)

3.2 Correction of homeostasis disorders

Correction of water and electrolyte balance is recommended to be carried out with crystalloid, colloid solutions and glucose under the control of pulse, blood pressure (BP) and central venous pressure (CVP), cardiac index, total peripheral resistance, hematocrit, hemoglobin and electrolyte concentrations, as well as diuresis.

Persuasiveness level - D(level of evidence - 4)

Comments:The volume of liquid introduced for this purpose averages 2.0-3.0 liters or more at a ratio of colloidal to crystalloid solutions of 1:3.

Persuasiveness level - D(level of evidence - 4)

Comments: During intoxication, the early elimination of COS disorders is important, since a long-term state of metabolic acidosis, which naturally develops with alcohol poisoning, can in itself have a pronounced adverse effect on various body systems.

To accelerate the metabolism of ethanol, normalize metabolic processes, a combination of intravenous administration of dextrose ** (10-20% solution of 500-1000 ml) with insulin (16-20 units) and a complex of vitamins (thiamine ** 5% solution of 3-5 ml, pyridoxine) is recommended ** 5% solution 3-5 ml, cyanocobalamin** 300-500 mcg, ascorbic acid** 5% solution 5-10 ml, thioctic acid** 0.5% solution 2-3 ml).

Persuasiveness level - D(level of evidence - 4)

In order to normalize energy metabolism, it is recommended to inject succinic acid preparations - ethylmethylhydroxypyridine succinate**, sodium meglumine succin**t, etc.

Persuasiveness level - D(level of evidence - 4)

To prevent Wernicke's toxic post-alcohol encephalopathy, administration of thiamine** (100 mg intravenously) is recommended.

Persuasiveness level - D(level of evidence - 4)

3.3 Detoxification

gastric lavage (PG) probe,

the introduction of a saline laxative (preferably sodium sulfate),

purgation.

Persuasiveness level - D(level of evidence - 4)

3.4 Accelerated detox

For a more intensive release of ethanol, the use of forced diuresis (FD) is recommended, which is carried out with urine alkalinization.

Persuasiveness level - D(level of evidence - 4)

With a deep coma with areflexia, no positive dynamics after the PD cycle, an extremely high level of ethanol (10 or more g / l) or higher alcohols in the blood, HD or HDF is recommended.

Persuasiveness level - D(level of evidence - 4)

In patients under 18 years of age for the treatment of alcohol poisoning, complex therapy is recommended, which includes detoxification (cleansing the gastrointestinal tract - washing the stomach with water at room temperature, strictly controlling the total amount of water used for this (no more than 1 liter in the first year of life, 1-3 liters from 1 years up to 6-7 years, 4-5 liters at the age of 8-15 years The amount of fluid administered intravenously for the implementation of FD is used at the rate of 7.0-8.0 ml / kg per hour), Symptomatic treatment is also carried out, administration vitamins that enhance the metabolism of ethanol.

Persuasiveness level - D(level of evidence - 4)