Structure of complications, causes of mortality, clinical and morphological parallels in acute poisoning with methadone hydrochloride
Background. The relevance of the study of methadone poisoning in Kyiv is determined by a significant increase in the number of poisonings among the population in recent years and high rates of mortality. The purpose of this study is to determine the factors that caused the fatal methadone poisonings in order to develop measures for reducing mortality among this category of patients. Materials and methods. The subject of the study is 35 cases of deaths due to the “street” methadone poisoning in 2005–2017 and the results of forensic medical examination of these patients. Results. The authors found that on average, the amount of methadone poisonings is 20 % of the total number of treated patients with acute poisonings. The highest mortality rates were recorded in 2009 (8.33 %) and in 2015 (7.82 %). The main causes of death were: high dose of poison, presence of concomitant diseases in drug addicts; complications in the toxicogenic phase of poisoning; development of complications in the somatogenic phase of poisoning. The analysis of the incidence and time of the deaths of patients with acute methadone poisoning demonstrates that 38 % of fatal cases were recorded on the first day after poisoning. The presence of chronic concomitant pathology of the nervous, respiratory, cardiovascular and digestive systems caused specific symptoms in methadone hydrochloride poisoning. It was found that rapid development of the early syndrome of multiple organ failure was due to the structure of existing chronic and/or acute infectious complications. Moreover, the cause of death in the toxicogenic stage of acute methadone poisoning was direct intoxication, in the somatogenic stage of poisoning, the main cause of death was pneumonia. We analyzed the structure of complications, identified infectious and non-infectious complications. The most common pathological syndrome among non-infectious complications is toxic hepatotoxicity — 34.3 % of all cases. Next is a syndrome of prolonged compression of soft tissues complicated by acute renal failure — 22.9 %. It should be noted that each fifth patient (20 %) had signs of aspiration of gastric contents at admission. Among this group of complications in the somatogenic phase of poisoning, there was the development of a syndrome, which is very common in acute poisoning, — apallic state (7 cases). In the structure of infectious complications manifested predominantly in the toxicogenic phase of poisoning, there were pneumonia, soft tissue necrosis and other septic complications. The peculiarity of complications structure in patients with methadone hydrochloride poisoning is a significant percentage of purulent pneumonia — 80 %. According to the histological study, the changes characteristic of the systemic inflammatory response syndrome have been detected on the first day after acute poisoning. Thus, the analysis of the incidence and time of deaths in patients with acute methadone hydrochloride poisoning and the findings of morphological studies have shown that 38 % of fatal cases were recorded on the first day after poisoning. In the structure of infectious complications, pneumonia and soft tissue necrosis prevailed. Among infectious complications — purulent pneumonia (80 %), among non-infectious — toxic hepatic nephropathy (34.3 %), and the incidence of prolonged soft tissue compression syndrome complicated by the development of acute renal failure is 22.9 %. According to the results of the morphological study, signs of systemic inflammatory process — sepsis were detected in 14.2 % of cases. The vast majority of drug addicts use illegal drugs, which eventually cause severe somatic pathology: damege to the cardiovascular system, respiratory organs, kidney, liver, soft tissues. Many years of experience with severe forms of drug addiction prove that the intravenous introduction of surrogate drugs without compliance with the rules of aseptics and hygiene, needle sharing by a group of drug addicts, aggressive introduction of narcotic substances lead to the development of infiltrates and soft tissue abscesses, sepsis, and, in turn, to severe forms of septic complications. It should be noted that infection develops on the background of the general depletion of the body, decreased reparative processes, secondary immunodeficiency. Conclusions. Methadone poisoning in Ukraine today is the most dangerous type of poisoning that is confirmed by high number of poisonings, the number of deaths, the early development of mortal complications, a long period of treatment, which requires the use of combined detoxification methods and a long period of rehabilitation.
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