The effect of intestinal lavage on the content of free hemoglobin in the blood in case of oral poisoning with acetic essence

Introduction. The fight against severe hemolysis because of oral poisoning with acetic acid is one of the top priorities and has not lost its relevance.

Purpose of the study. To evaluate the effectiveness of intestinal lavage as a detoxification method for acute hemolysis associated with oral acetic acid poisoning.

Material and methods. A prospective study was carried out on 73 patients (study and comparison groups) with acetic acid poisoning (men and women aged 47 (34.0; 57.5) and 42 (32.5; 54.5) years in the corresponding comparison groups), located in 2017–2022 in the Department of acute poisoning and somatopsychiatric disorders of the State Budgetary Healthcare Institution “Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow City Department of Health”. The study was preliminarily approved by the Biomedical Ethics Committee (extract from protocol No. 5-16 dated November 21, 2016). Of the total number of 38 patients in the study group, within 6 hours of taking the poison as part of a complex treatment for the purpose of detoxification and correction of homeostasis disorders, a six-hour intestinal lavage (IL) was performed in a volume of 12 liters of enteral solution administered in the form of a drink or through gastric tube. The comparison group consisted of 35 patients who underwent standard therapy without IL. In both groups, the content of free hemoglobin in the blood and urine was recorded before the start and at subsequent stages of treatment.

Results. The patients tolerated IL satisfactorily; there were no reactions or complications. As a result of IL, the content of free hemoglobin in the blood decreased from the initial level of 11.2 (9.8; 12.5) mg/ml, and in the urine from 21.0 (18.2; 22.3) mg/ml. to zero in 6 (5; 7) hours. In the comparison group, the content of free hemoglobin in the blood decreased exponentially from the initial level of 12.1 (10.3; 13.4) mg/ml and in the urine from 16.1 (14.9; 18.7) mg/ml to zero for 16.2 (15.1; 18.8) hours. Thus, in the study group, hemolysis was eliminated on average 10 hours earlier than in the comparison group. This difference was statistically significant (p<0.05).

Limitations. The study concerned the effectiveness of IL as a method of detoxification in acute hemolysis in male and female victims of acute oral poisoning with acetic acid, the limitations of which were: nosological form — oral poisoning with acetic acid, the presence of free hemoglobin in the blood and urine, in a concentration, corresponding to severe poisoning, up to 6 hours from the moment of ingestion of the poison, patient age 47 (34.0; 57.5) and 42 (32.5; 54.5) years, volume of enteral solution 12 l for perfusion of the gastrointestinal tract during IL.

Conclusion. An analysis of the facts presented in works describing the migration of free hemoglobin in the lymphatic and circulatory systems, as well as our own experience of using IL in case of acetic acid poisoning, indicate that hemolysis does not occur inside the blood vessels, but free hemoglobin enters the blood from the lymphatic system therefore and it can not be talking about “intravascular hemolysis”, but about hemoglobinemia, which is a consequence of hemolysis of escaping blood from the arrozed vessels of the gastrointestinal tract under the influence of acetic acid, subsequent absorption of free hemoglobin into the lymph and migration with it into the circulatory system. The results of the study showed that the inclusion of IL in the treatment regimen for severe acetic acid poisoning with severe hemolysis helps to accelerate the elimination of free hemoglobin from the body by stopping the absorption of the latter from the gastrointestinal tract.

Compliance with ethical standards. The protocol of this study was approved by the local ethics committee of the State Budgetary Healthcare Institution “Research Institute for Emergency Medicine named after N.V. Sklifosovsky of the Moscow City Department of Health” No. 5-16 dated 21/11/2016.

Authors contribution:
Matkevich V.A. — the concept and design of the study, the proposed hypothesis of hemolysis, writing text;
Potshveriya M.M. — development of the design of the study and its organization;
Stolbova N.E. — collection, systematization, statistical processing and analysis of data;
Ilyashenko K.K., Belova M.V. — discussion of the results and preparation of printed materials on the use of intestinal lavage in poisoning with corrosive substances.
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 author declares no conflict of interest.

Funding. The study had no sponsorship.

Received: January 25, 2024 / Accepted: May 5, 2024 / Published: June 28, 2024