Substantiation of intensive care and extracorporeal detoxification measures for combined methadone poisonings
Keywords:methadone, acute poisonings, hemodialysis, plasmapheresis, ozone therapy
AbstractBackground. The problem of acute poisoning by illegal or “street” methadone in Ukraine today has gone beyond drug or psychiatric practice, and has become a real test for intensive care units specializing in the treatment of poisonings. Acute methadone poisoning in combination with other psychoactive substances, including ethanol, is often accompanied by soft tissue ischemia and acute kidney damage, which requires the use of extracorporeal treatment methods. The purpose was to study the effectiveness of the early use of hemodialysis with ultrafiltration, membrane plasmapheresis and blood ozonation in the comprehensive therapy of acute methadone poisoning. Materials and methods. One hundred and eighty-six cases of methadone poisoning were studied. Patients of both sexes, aged 21 to 43 years, were treated in the intensive care and extracorporeal treatment unit of the Kyiv City Clinical Emergency Hospital in 2018–2019. Based on Poisoning Severity scale (PSS) (Persson H.E., 1998) all patients were divided into three groups. Group I: n = 21, moderate poisoning (PSS: from 0 to 2.0 points); group II: n = 79, severe poisoning (PSS: more than 2.0 up to 3.0 points); group III: n = 86, extremely severe poisoning (PSS: more than 3.0 up to 4.0 points). Clinical, biochemical, functional, chemical-analytical, statistical research methods are used. Indicators in the groups were compared using Student’s t-test for independent samples; differences were considered statistically significant at p ≤ 0.05. Results. According to the results of clinical, functional and laboratory examination of patients with combined methadone poisoning, toxic hepatopathy and nephropathy was revealed in 34.3 % of patients, soft tissue ischemia syndrome with oliguria-anuria — in 22.9 %. The causes of renal failure were both prerenal (hypovolemia, low cardiac output, decreased renal vascular tone) and renal factors (toxic damage to the renal parenchyma). Indications for hemodialysis in patients with severe methadone poisoning were: oliguria-anuria for 24 hours; increase of creatinine, urea, lactate, creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase levels; water-electrolyte imbalance; brain edema; soft tissue ischemia syndrome (≥ 5 % of body area) and the risk of vascular thrombosis. Continuous venous-venous hemodialysis and ultrafiltration were used in 86 patients with acute renal damage. Conclusions. A variety of disorders of homeostasis in combined methadone poisoning, in particular with soft tissue ischemia syndrome, requires the early use (within 24–48 hours) of extracorporeal therapy methods. Among these methods, continuous veno-venous hemodialysis with ultrafiltration, membrane plasmapheresis and ozone therapy (intravenous saline and autohemotransfusion of ozonated blood) were effective.
Kuchma A.B., Struck V.F., Padalka V.M. Analysis of the load on the intensive care unit and the hospital stage of emergency care at the expense of patients with acute methadone poisoning. Emergency medicine. 2016. №4 (75). Electronic resource. URL: http://www.mif-ua.com/archive/article/43204.
Nedashkivsky S.M. Acute renal failure in severe methadone poisoning. Emergency medicine. 2015. №1 (64). Electronic resource. URL: http://www.mif-ua.com/archive/article/40225.
Andryushchenko V.V. Kalish N.M, Kurdil N.V. The features of the course of combined poisonings with “street” methadone. Emergency medicine. 2018. 1 (88). P.136-141. doi:10.22141/2224-0522.214.171.1248.124981.
Andryushchenko V.V. Kalish N.M, Kurdil N.V. Structure of complications, causes of mortality, clinical and morphological parallels in acute poisoning with methadone hydrochloride. Emergency medicine. 2018. 2(89). Р.104-109. doi:10.22141/2224-05126.96.36.1998.126611.
Ivashchenko O.V., Andryushchenko V.V., Bogomol A.G., Kalish M.M., Kurdil N.V. Modern approaches of the diagnostics and intensive care of combined methadone poisonings in the specialized Toxicological Centre. Ukrainian Medical Journal. 2 (124) – III/IV 2018. P.34-37. doi:10.32471/umj.1680-3051.124.125260.
Andryuschenko V.V., Kurdil N.V. Characteristics of haematological toxicity indices in combined poisoning with methadone and ethanol complicated by acute renal failure. Ukrainian Journal of Modern Problems of toxicology. 2019. №2. p. 34-43. doi:10.33273/2663-4570-2019-86-2-34-43.
Ivashchenko OV, Nedashkivsky SM Features of clinic, diagnostics and treatment at methadone poisoning. Emergency medicine. 2009. №5 (24). Electronic resource. URL: http://www.mif-ua.com/archive/article/11160.
Patent 74280 of Ukraine, G 01 N 33/48, A 61B 10/00. Method of choosing the method of detoxification therapy / M.G. Prodanchuk, B.S. Sheiman, O.I. Osadcha, N.O. Voloshin (Ukraine); applicant and patent holder of the Institute of Ecology and Toxicology. L.I. Bear. - № 74280; declared 22.01.04; publ. 11/15/05 Bull. № 11.
Patent 76227 of Ukraine, G 01 N 33/48, A 61B 10/00. Method for diagnosing the etiological factor of toxemia / M.G. Prodanchuk, B.S. Sheiman, O.I. Osadcha, N.O. Voloshin (Ukraine); applicant and patent holder of the Institute of Ecology and Toxicology. L.I. Bear. - № 76227; declared 19.05.04; publ. 07/17/06 Bull. № 7.
Copyright (c) 2020 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.