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Narcotic poisoning

It often occurs as a result of abuse of narcotic substances (narcoman a), more rarely — in intake of these substances by chance or with suicidal aim. It may develop after a peroral intake, smoking or injection of dried poppy juice, hemp infusion, opium extract or infusion. The same is referred to other preparations containing morphine and its derivatives in the form of powder, tablets, ointment and solution, the majority of which are used in medicine (ethylmorphine hydrochloride in the form of cough agents, eye drops and ointments, heroin, codeine, etc.).

Synthetic preparations also have narcotic properties that are used for anesthesia, preparation for narcosis (fentanyl, pentazocin or lexir, petidin, dipidolor, etc.). After an absorption of the dose from a digestive tract, lungs, place of subcutaneous or intramuscular injection, more rarely through the intact skin or just after an intravenous injection rapidly appear a hyperemia of the face, dizziness, feeling of heat and thirst, nausea (sometimes, vomiting), hallucinations, loss of orientation, then coma (up to 2 days and more).

Paleness of skin (unlike alcoholic poisoning when skin and mucous
membranes are hyperemic), bradycardia, decrease of AP, slow irregular
breathing (pathologic respiration of Cheyne-Stokes type is possible), cyanosis,
areflexia, hypothermia are characteristic of coma. As a result of spasm of
sphincters of the stomach, the intestine and urinary bladder turn out to be
overfdled. A death comes from a respiratory arrest (before a cardiac arrest) in
2-12 hours. ^v

Pneumonia, cardiovascular insufficiency and pulmonary edema may develop in the period of coma. After recovery from coma, a repeated coma is possible. Defecation and urination are disturbed, pronounced weakness and encephalopathy because of prolonged cerebral hypoxia develop. Sometimes, (for example, in cocaine or petidin poisoning) convulsions, visual disorder and hypothermia arise. In case of a fall fractures of bones, craniocerebral injury are possible.

Treatment is carried out according to general principles of therapy of poisonings. In peroral poisoning it is better to fulfil a gastric lavage with 0.05-0.1% potassium permanganate solution. One cannot apply emetics. After vomiting it is recommended to drink a hot strong coffee. In injection type of poisoning a tourniquet is applied on the extremity above the place of injection removing it for a short time every 15 min. Around the place of injection 1 ml 0.1% adrenalin solution per 20 ml NaCl isotonic solution is introduced and an ice bag is applied to this place.

5-10 ml 0.5% nalorphine or naloxone (antidote of morphine) solution are slowly intravenously introduced. When one is sure in the diagnosis and in absence of effect the same dose of antidotes is administered repeatedly in 15-30 min. and further it is repeated every 2 hours up to normalization of respiration and reflexes. An infusion therapy with forced diuresis is carried out with compulsory catheterization of urinary bladder (spasm of sphincters!). Antibiotics are also introduced. Application of bemegride and other psychoanaleptic agents is not recommended.

In the period of coma a patency of respiratory tract is supported, a careful nursing is provided and symptomatic therapy is carried on. In development of respiratory failure it is necessary to perform APV and oxygen inhalation.

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