АкушерствоАнатомияАнестезиологияВакцинопрофилактикаВалеологияВетеринарияГигиенаЗаболеванияИммунологияКардиологияНеврологияНефрологияОнкологияОториноларингологияОфтальмологияПаразитологияПедиатрияПервая помощьПсихиатрияПульмонологияРеанимацияРевматологияСтоматологияТерапияТоксикологияТравматологияУрологияФармакологияФармацевтикаФизиотерапияФтизиатрияХирургияЭндокринологияЭпидемиология

Poisoning with acetic essence

When an acetic acid gets into the organism it causes severe burns of the gastrointestinal tract with development of clinical picture of burn disease, hemolysis and quite often it is accompanied by renal and hepatic insufficiency.

A leading clinical manifestation is shock. A clinical picture of shock is accompanied, as a rule, by a number of complications: hemorrhages from an admixture of blood in wash waters to massive esophageal and gastrointestinal hemorrhages, in a number of cases hemorrhages may be recurrent. A shock is accompanied by mechanical asphyxia as a result of burn and edema of the mucous membrane of the larynx and the upper respiratory tract. Clinically, a pronounced patient's excitation is noted, inspiratory dyspnea with participation of auxiliary respiratory musculature, cyanosis, quite often stridulous breathing accompanied by rapidly progressing collapse, in particularly grave cases — motor excitation with subsequent loss of consciousness.

In burns of the epiglottis a leakage of liquid, while deglutition, or gastric content into the trachea is noted.

A burn, as a rule, is accompanied by sharp painfulness along the esophagus and dysphagia in the course of 2-10 days.

In burns of the stomach the patients complain of pain in the epigastric region, in severe cases — with local muscular tension of the abdominal wall and symptoms of peritoneal irritation in the epigastric region.

Sometimes, girdle pains may be as manifestation of pancreatonecrosis.

A burn of the digestive tract is accompanied by plasmorrhagia leading to pachyemia with the increase of hemoglobin and hematocrit indices.

Hemolysis is characterized by a decrease of hemoglobin level, elevation of free hemoglobin concentration in blood plasma from 100-500 mg%, in mild degree, to 1000 mg% and higher, rapidly adds a hemoglobinuria arising when a renal threshold of hemoglobin (more than 100 mg%) increases. In severe hemolysis the attention is drawn to the appearance of areas of striking hyperemia, yellowness of skin, mucous membranes and sclera on the background of pale-cyanotic skin.

Symptoms of shock and hemolysis are accompanied by pronounced acidosis, hemoconcentration and quite often they proceed with functional disorders of the liver and kidneys.

Nephropathy is manifested with hematuria, hemoglobinuria, proteinuria, cylindruria and oliguria. The colour of the urine is from red to dark cherry. A change in the urine appears by the end of the first 24 hours following the poisoning and in mild forms it is not revealed 3 days later. In extremely grave cases ARF develops with the change of biochemical findings — increase of residual nitrogen, urea and blood creatinine contents.

Toxic hepatitis is characterized by enlargement and tenderness of the liver, increase of content of transaminases, aldolase, bilirubin and ammonia in blood.

A sharp psychomotor excitation with auditory and visual hallucinations (delirium) and expressed hyperthermia are noted, as a rule, in severe injury on the 2-3 days following the poisoning.

A death rate in poisoning with acetic acid makes up 25%, of them 64.5% — from shock, the second place, as the cause of death, is taken by aspiration confluent bronchopneumonia, on the third place — an acute renal or hepatic insufficiency.

Treatment:

Narcotics, spasmolytics are administered i/m or i/v. Droperidol and fentanyl exert a good effect.

After a removal of pain syndrome a gastric lavage is performed through a tube.

Infusion therapy consists of the administration of glucose novocainic mixtures (10-20% glucose 500-1000 ml and 30-50 ml 2% novocaine solution). To restore VCB it is necessary to infuse up to 2-3 1 of electrolyte solutions, plasma and macro-molecular blood substitutes in the first 24 hours. In persistent prolonged shock it needs to administer low-molecular solutions up to 2-2.5 1 that is of great significance for restoration of disturbed blood microcirculation and allows to maintain normal AP without application of pressor amines (adrenalin, norepinephrine, mesaton) that aggravate a microcirculation in shock.

In hemolysis the principle attention is paid to alkalinization of plasma under pH control in combination with a forced diuresis for a rapid clearance of the

kidneys from hemoglobin residues and restoration of diuresis. With this purpose a 4% sodium bicarbonate solution 500-2000 ml a day is applied with maintenance of the urine pH within 8.0-8.5. Hypertonic 10-20% glucose solutions are administered, as well as euphilline and novocaine. As diuretics, lasix to 2000 mg a day and mannitol — 1-1.5 g/kg body weight in the form of 10-15% solution are used. In this period a correction of electrolyte disorders is of great significance.

An operation on blood substitution in grave shock is contraindicated in view of hemodynamic disorders and its use in the patients with stable hemodynamics has no advantages over plasma alkalinization with a forced diuresis.

Prednisolone is administered up to 90 mg a day, hydrocortisone to 250 mg a day, ACTH — 40 U a day. Hormonotherapy is directed to treatment of hypotension and prevention of esophageal stenosis along a digestive tract be mg a good antiinflammatory means. It starts early and lasts up to 3-4 hours. Along with hormones spasmolytics (atropine, platyphyllin, papaverine) are applied. A bouginage of the esophagus is not recommended in the early period.

In esophagogastric hemorrhages — a hemostatic therapy: vicasol, 10% calcium gluconate or chloride, aminocaproic acid, fibrinogen and fractioial blood transfusions.

The application of antibiotics, dietetics and parenteral protein feeding is of great significance in complex treatment of burns.

Дата добавления: 2015-02-05 | Просмотры: 814 | Нарушение авторских прав