A case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock (clinical observation)

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Introduction. The article considers a case of a favorable outcome of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree, complicated by the development of acute respiratory failure and exotoxic shock.

Clinical observation. An episode of acute oral poisoning with a mixture of narcotic and psychoactive substances of severe degree (baclofen, (4-amino-3-(4-chlorophenyl) is presented-butyric acid — ethylglucuronide >2000 mg/ml), methadone 83 mg/ml, methylenedioxypyrovaleron 57 ng/ml, complicated by the development of exotoxic shock in a 32-year-old patient. The clinical picture of acute poisoning was manifested by depression of consciousness to the level of coma II, acute respiratory failure, mixed respiratory and metabolic acidosis (pH 7.18; partial pressure of carbon dioxide 64.0 mmHg, lactic acidosis up to 5 mmol/l), swelling of the brain, exotoxic shock (BP — 60/20 mmHg, heart rate — 110 beats per minute).

Intensive therapy included: respiratory, infusion, detoxification, anticoagulation, antibacterial therapy, correction of acid-base state disorders, water-electrolyte balance, nutritional support, normalization of metabolic disorders through the use of a substrate antihypoxant. The calculation of the required amount of sodium bicarbonate was carried out according to the Mellengaard-Astrup formula: the amount of mmol of sodium bicarbonate is equal to the product of VE • body weight in kg • 0.3. According to the calculation, the amount of required bicarbonate was 195 mmol, that is, in terms of 5% bicarbonate solution — 195 ml.

Conclusion. As a result of basic resuscitation care in the form of artificial lung ventilation, correction of mixed respiratory and metabolic acidosis by using sodium bicarbonate, infusion therapy to correct hypovolemia, ensuring optimal perfusion of organs and tissues, elimination of key links of hypoxia by using cytoflavin, improvement of rheological properties of blood and symptomatic therapy allowed for a favorable outcome of severe poisoning with a mixture of narcotic and psychoactive substances complicated by the development of exotoxic shock.

Compliance with ethical standards. The study was approved by the Local Ethics Committee of the I.I. Janelidze St. Petersburg Research Institute of SP Protocol No. 1 of 12.02.2022.

Author contribution:
Narzikulov R.A. — concept and design of the study, collection and processing of material, writing of the text;
Lodyagin A.N. — concept and design of the study, editing;
Sinenchenko A.G., Batotsyrenov Ch.B. — collection and processing of material;
Lisitsyna I.A., Zapadnikov N.D., Rustamov B.R. — writing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Conflict of interest. The authors declare that there are no conflicts of interest.

Financing. The study had no sponsorship.

Received: January 23, 2023 / Accepted: May 26, 2023 / Published: June 30, 2023

About the authors

Rustam Abdukhalimovich Narzikulov

Vsevolozhsk Clinical Interdistrict Hospital; St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Author for correspondence.
Email: rnarzikulov@yandex.ru
ORCID iD: 0000-0002-6788-3050

MD, Senior Researcher of the Department of Clinical Toxicology of the I.I. Janelidze Research Institute of Emergency Medicine, St. Petersburg, 192242.

e-mail: rnarzikulov@yandex.ru

Russian Federation

Alexey Nikolaevich Lodyagin

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: alodyagin@mail.ru
ORCID iD: 0000-0002-8672-2906

Доктор медицинских наук, доцент, руководитель отдела клинической токсикологии ГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе», 192242, г. Санкт-Петербург, Российская Федерация.

e-mail: alodyagin@mail.ru

Russian Federation

Andrey Georgievich Sinenchenko

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: nachsml@mail.ru
ORCID iD: 0000-0003-2815-3108

Кандидат медицинских наук, руководитель отдела неотложной психиатрии, наркологии и психореабилитации ГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе», 192242, г. Санкт-Петербург, Российская Федерация.

e-mail: nachsml@mail.ru

Russian Federation

Чимит Баирович Батоцыренов

Pavlov First St. Petersburg State Medical University

Email: noemail@neicon.ru
ORCID iD: 0000-0002-2693-6283

Клинический ординатор кафедры анестезиологии и реаниматологии ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» МЗ РФ, 197022, г. Санкт-Петербург, Российская Федерация.

e-mail: nachsml@mail.ru

Russian Federation

Bezhan Rustamovich Rustamov

Pavlov First St. Petersburg State Medical University

Email: noemail@neicon.ru

Студент лечебного факультета ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» МЗ РФ, 197022, г. Санкт-Петербург, Российская Федерация.

e-mail: nachsml@mail.ru

Russian Federation

Ivan Alexandrovich Lisitsa

Vsevolozhsk Clinical Interdistrict Hospital; Federal State budgetary Educational Institution of Higher Education «St.Petersburg State Pediatric Medical University» of the Ministry of the Russian Federation

Email: noemail@neicon.ru

Врач-анестезиолог-реаниматолог ОАР с ПРИТ для взрослого населения ГБУЗ ЛО «Всеволожская межрайонная больница», 188643, Ленинградская область, Российская Федерация; ассистент кафедры общей медицинской практики ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» МЗ РФ, 194100, г. Санкт-Петербург, Российская Федерация.

e-mail: nachsml@mail.ru

Russian Federation

Nikita Dmitrievich Zapasnikov

Vsevolozhsk Clinical Interdistrict Hospital

Email: noemail@neicon.ru

Заведующий отделением ОАР c ПРИТ для взрослого населения ГБУЗ ЛО «Всеволожская межрайонная больница», 188643, Ленинградская область, Российская Федерация.

e-mail: nachsml@mail.ru

Russian Federation

References

  1. The United Nations. Report of the International Committee on Drug Control for 2019 [Organizaciya Ob”edinennyh Nacij. Doklad Mezhdunarodnogo komiteta po kontrolyu nad narkotikami za 2019 g. (E/INCB/2019/1)] . Vena: 2020; 172 . (in Russian)
  2. Lodyagin A.N., Batocyrenov B.V., Shilov V.V., Shikalova I.V., Balabanova O.L. Analysis of the structure of acute poisoning by modern psychoactive substances. Gigiena i sanitariya. 2020; 99(6): 569–74. https://doi.org/10.47470/0016-9900-2020-99-6-569-574 (in Russian)
  3. Borisenko M.V., Kal’yak A.M. Analysis of the situation of drug consumption, drug trafficking and the fight against their illicit trafficking at the present time. Interaktivnaya nauka. 2017; 4(14): 170–172. (in Russian)
  4. Al Alaywa K., Jouffroy R., Le B.C., Rapalen J.H., Lamhaut L., Le Louet A.L., et al. Toxicological Analysis Unveiling the Low Rate of Self-Reporting of Addictive/Recreative Substances in Acute Severe Drug Overdose Cases. Turk J Anaesthesiol Reanim. 2020; 48(3): 264. https://doi.org/10.5152/TJAR.2019.28003
  5. Hinojosa R., Baud F., Marque S., Barreteau H. Intoxications graves en réanimation: étude des substances annoncées en 2011 [Severe poisonings in intensive care unit: study of announced substances in 2011]. Ann Pharm Fr. 2013; 71(3): 174–85. https://doi.org/10.1016/j.pharma.2013.02.002
  6. Andersson J.A., Brekke M., Vallersnes O.M. Acute poisoning from substance abuse of benzodiazepines. Tidsskr Nor Laegeforen. 2020; 140(10). https://doi.org/10.4045/tidsskr.20.0035
  7. Wilde M., Sommer M.J., Auwärter V., Hermanns-Clausen M. Acute severe intoxication with cyclopropylfentanyl, a novel synthetic opioid. Toxicol Lett. 2020; 320: 109–12. https://doi.org/10.1016/j.toxlet.2019.11.025
  8. Batocyrenov B.V., Livanov G.A., Andrianov A.Yu., Vasil’ev S.A., Kuznecov O.A. Features of the clinical course and correction of metabolic disorders in patients with severe methadone poisoning. Obshchaya reanimatologiya. 2013; 9(2): 18–22. https://doi.org/10.15360/1813&9779&2013&2&18 (in Russian)
  9. Zaikina O.L., Lodyagin A.N., SHilov V.V. Gamma-oxybutyrate and fentanyl derivatives: chemical and toxicological confirmation of poisoning. Sudebnaya medicina. 2016; 2(2): 112–3. (in Russian)
  10. Chevillard L., Mégarbane B., Baud F.J., Risède P., Declèves X., et al. Mechanisms of respiratory insufficiency induced bymethadone overdose in rats. Addict. Biol. 2010; 15(1): 62–80. https://doi.org/10.1111/j.1369&1600.2009.00184.x
  11. Erwan Le G., Mesli V., Cornez R., Demarly C., Tournel G., et al. Fatal Overdose of Gamma-hydroxybutyrate Acid After Ingestion of 1,4-Butanediol. J Forensic Sci. 2018; 63(1): 326–9. https://doi.org/10.1111/1556-4029.13510
  12. Resiere D., Kallel H., Oxybel O., Chabartier C., Florentin J., et al. Clinical and Epidemiological Characteristics of Severe Acute Adult Poisoning Cases in Martinique: Implicated Toxic Exposures and Their Outcomes. Toxics. 2020; 8(2): 28. https://doi.org/10.3390/toxics8020028
  13. Mehrpour O., Akbari A., Jahani F., Amirabadizadeh A., Allahyari E., et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med. 2018; 18(1): 30. https://doi.org/10.1186/s12873-018-0181-6
  14. Analyzer for chemical and toxicological studies IK 200609. FSZ no. 2010/07075. Operation manual [Analizator dlya ximiko-toksikologicheskix issledovanij IK 200609. № FSZ 2010/07075. Rukovodstvo po e`kspluatacii]. Moscow: 2016; 48. (in Russian)

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2023 Narzikulov R.A., Lodyagin A.N., Sinenchenko A.G., Батоцыренов Ч.Б., Rustamov B.R., Lisitsa I.A., Zapasnikov N.D.



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 81728 от 11 декабря 2013.