Substantiation of intensive care and extracorporeal detoxification measures for combined methadone poisonings

Authors

  • V.V. Andryushchenko Kyiv City Clinical Emergency Hospital, Kyiv, Ukraine
  • N.V. Kurdil State Enterprise “L.I. Medved Scientific Center of Preventive Toxicology, Food and Chemical Safety of the Ministry of Health of Ukraine”, Kyiv, Ukraine http://orcid.org/0000-0001-7726-503X
  • M.M. Kalish Kyiv City Clinical Emergency Hospital, Kyiv, Ukraine
  • V.F. Struk State Institution “Ukrainian Scientific and Practical Center of Emergency and Disaster Medicine of the Ministry of Health of Ukraine”, Kyiv, Ukraine
  • V.M. Padalka State Institution “Ukrainian Scientific and Practical Center of Emergency and Disaster Medicine of the Ministry of Health of Ukraine”, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.6.2020.216510

Keywords:

methadone, acute poisonings, hemodialysis, plasmapheresis, ozone therapy

Abstract

Background. 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.

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Published

2020-09-01

Issue

Section

Original Researches